In selected patients with left ventricular assist device–associated infection or malfunction, pump exchange may become necessary after conservative treatment options fail and heart transplantation is not readily available. We examined the survival and complication rate in patients (⩾19 years of age) who underwent HeartMate II to HeartMate II exchange at our institution from 1 January 2010 to 28 February 2018. Clinical outcomes were analyzed and compared for patients who underwent exchange for pump thrombosis (14 patients), breach of driveline integrity (5 patients), and device-associated infection (2 patients). There were no differences in 30-day mortality (p = 0.58), need for temporary renal replacement therapy (p = 0.58), right ventricular mechanical support (p = 0.11), and postoperative stroke (p = 0.80) among groups. Survival at 1 year was 90% ± 7% for the whole cohort and 85% ± 10% for those who underwent exchange for pump thrombosis. In patients exchanged for device thrombosis, freedom from re-thrombosis and survival free from pump re-thrombosis at 1 year were 49% ± 16% and 42% ± 15%, respectively. No association of demographic and clinical variables with the risk of recurrent pump thrombosis after the first exchange was identified. Survival after left ventricular assist device exchange compares well with published results after primary left ventricular assist device implantation. However, recurrence of thrombosis was common among patients who required a left ventricular assist device exchange due to pump thrombosis. In this sub-group, consideration should be given to alternative strategies to improve the outcomes.

and pre-implant MR ≥ moderate. RHF was defined as the need for unplanned right ventricular assist device (RVAD) or post-LVAD inotropic support for either ≥ 14 days (RHF-14d) or, more conservatively, ≥ 21 days (RHF-21d), consistent with our previously reported outcomes. Results: Fourteen patients (7%) required RVAD, 24 (12%) required inotropes for ≥ 21 days and 35 (18%) for 14-20 days. After adjustment for pulmonary artery wedge pressure, pulmonary vascular resistance, and heart rate, MR severity was inversely related to PACi (p = 0.015) and was a determinant of PACi in linear regression modeling (p = 0.037). There was a significant association between PACi/MR category and the incidence of RHF (Figure), and 57% of patients requiring RVAD were in the Low PACi/Less MR group. In multivariate logistic regression, PACi and MR were strongly associated with RHF-21d (Figure), and there was a significant interaction between these variables (p-interaction < 0.05). Conclusion: Greater MR severity is associated with increased RV pulsatile load but reduced rates of early RHF after cfLVAD. These findings suggest that MR represents a unique, LVAD-responsive RV load, and this paradigm may help risk stratify patients for post-LVAD RHF.

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Background: Literature shows that interdisciplinary huddles help promote clear communication and proactive reporting of potential errors. Local Problem: High reliability organization (HRO) and just culture models were implemented, yet fragmented team communication about patient safety remained. Huddles were implemented to identify and address patient safety issues. Methods: A pre/postintervention design was used. Near-miss and actual event safety metrics, patient satisfaction, and employee satisfaction/work group perceptions were measured at 3 time points over 1 year. Interventions: Daily interdisciplinary huddles were implemented to improve communication, reduce errors, and improve patient and employee satisfaction. Results: Near-miss reporting increased across time points. Patient satisfaction with how the staff worked together to provide care significantly increased over time. Employee satisfaction and perception of work group communication, collaboration, and psychological safety scores improved, however, were not statistically significant. Conclusion:Implementing huddles demonstrated improved outcomes in patient safety, patient satisfaction, and employee satisfaction/work group perceptions.