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OBJECTIVES Limited data are available for use of the HeartMate 3 (HM 3) left ventricular assist device in patients with a small body surface area (BSA). Because the HM 3 is currently the sole device available worldwide, we conducted a single-centre retrospective study of patients with a small BSA (<1.5 m2) who underwent HM 3 implantation to better understand the operative and postoperative management. METHODS This study enrolled 64 consecutive patients who had undergone HM 3 implantation from August 2018 to July 2021. The patients were divided into 2 groups based on their BSA before the operation: BSA of <1.5 m2 (small BSA group, n = 18) and BSA of ≥1.5 m2 (regular BSA group, n = 46). The primary study endpoint was survival free of events such as disabling stroke and pump failure. The secondary endpoint was the frequency of adverse events. RESULTS The average BSA was 1.38 m2 in the small BSA group. The overall event-free survival rate at 12 months was 100% and 86.7% in the small BSA group and regular BSA group, respectively, and no significant difference was found between the 2 groups (log-rank P = 0.2). The number of cumulative adverse events of death, stroke of any severity, driveline infection, pump infection, ventricular arrhythmia, gastrointestinal Haemorrhage and pump failure was similar between the 2 groups. CONCLUSIONS The HM 3 was safely implanted in patients with a small BSA, and postoperative outcomes were acceptable regardless of BSA. However, further research is needed to confirm the indications for HM 3 implantation in even smaller patients.

LVADs, many patients still experience LVAD-specific complications such as stroke, infections (including driveline exit site or the LVAD pump itself), and device failure. 6-8 HeartMate 3 (HM3; Abbott Laboratories, Chicago, IL, USA) which is a fully magnetically levitated centrifugalflow pump, was developed as a next-generation LVAD. Several international trials have already demonstrated its superiority over previous axial-flow pumps for event-free survival. 9,10The clinical outcomes of LVADs with axial-flow pumps in Japanese cohorts were superior to those in other countries, 11,12 but the clinical results of new centrifugal LVAD remain to be evaluated. Herein, we demonstrate the short-term outcomes of HM3 implantation in comparison L eft ventricular assist devices (LVADs) provide improvements in survival and quality of life for patients with advanced heart failure (HF). 1,2 In the past decade, the indication for LVAD implantation has expanded not only as a bridge to transplantation (BTT) but also as destination therapy (DT) for patients ineligible for heart transplantation in the USA and Europe, and the clinical results in both BTT and DT patients have improved. [3][4][5] With technological advances, LVADs with continuous axial-flow pumps have been developed, making them smaller, with fewer moving parts (less biological reaction), and greater durability compared with the older models. 1,2 However, considering the prolonged support time of

A bridging strategy from extracorporeal life support (ECLS) is effective in salvage and a bridge to recovery or to a durable left ventricular assist device (LVAD) for acute refractory heart failure. However, the correlation of this strategy with adverse events after durable LVAD implantation has not been fully investigated. This study enrolled 158 consecutive patients who had either the HeartMate II or HeartMate 3 and were implanted for bridge-to-transplantation. These devices were implanted as the primary mechanical support device in 115 patients, whereas the remaining 43 underwent LVAD implantation as the bridge from central ECLS. The primary study endpoint was all-cause mortality and cerebrovascular accidents (CVAs) after durable LVAD implantation, and the secondary endpoints were adverse events. Overall survival was not significantly different between the two groups. In contrast, the probability of CVAs was significantly greater in the bridge group than in the primary group (probability of CVAs, P = 0.002; log-rank test). In Cox multivariate logistic regression analysis, a bridge from central ECLS was an independent predictive factor of CVAs (hazard ratio 4.27, 95% confidence interval 1.43–12.8; P = 0.0095). Patients who are bridged from central ECLS are more frequently complicated by CVAs compared with those who undergo primary implantation of a durable LVAD, but survival is not significantly different between the two groups. A bridge from central ECLS is an independent predictive factor of CVAs post-implantation of an LVAD.

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