Continuous‐flow LVAD exchange to a different pump model: Systematic review and meta‐analysis of the outcomes

Abstract

Despite improved outcomes of modern continuous‐flow left ventricular assist devices (CF‐LVADs), device exchange is still needed for various indications. While the majority of CF‐LVADs are exchanged to the same model, exchange to a different pump model is occasionally warranted. In this meta‐analysis, we sought to consolidate the existing evidence to better elucidate the indications and outcomes in these cases. A comprehensive systematic search of adult patient cohorts who underwent CF‐LVAD exchange to a different CF‐LVAD model was performed. Study‐level data from 10 studies comprising 98 patients were extracted and pooled for analysis. Mean patient age was 58 (95% CI: 48‐65) and 81% were male. Indication for initial CF‐LVAD was ischemic cardiomyopathy in 45% (34‐57). Initial device was HeartMate II LVAD (HMII) in 93 (94.9%) and HeartWare HVAD (HW) in 5 (5.1%) patients. After mean CF‐LVAD support time of 18.8 (15.2‐22.4) months, exchange indications included thrombosis in 71% (43‐89), infection in 21% (8‐47) and device malfunction in 12% (7‐21). HMII to HW exchange occurred in 53 (54.1%) patients, HMII to HeartMate III (HM3) in 32 (32.7%), and HM II to either HW or HM3 in 13 (13.2%) patients. Postoperatively, right ventricular assist device was required in 16% (8‐32). Overall, 20% (8‐40) of patients experienced a stroke, while HW patients had a significantly higher stroke incidence than HM3 patients (HW: 21% (8‐47) vs. HM3: 5% (1‐24), P < .01). Overall 30‐day mortality was 10% (6‐17), while HW had a significantly worse 30‐day mortality than HM3 (HW: 13% (7‐24) vs. HM3: 5% (1‐24), P = .03). Following device exchange from a different CF‐LVAD model, HM3 is associated with lower stroke and higher survival when compared to HW.

Rescue extracorporeal life support as a bridge to durable left ventricular assist device

“…Nevertheless, controversy surrounds this area as there is no clear evidence of superiority of any LVAD device. [19][20][21] Theoretically, the prevalence of an older HVAD device in our study might be considered a study limitation.…”

HVAD to HeartMate 3 left ventricular assist device exchange: Best practices recommendations

“…A recent systematic review estimated the risk of 30day mortality for pump exchange in the setting of changing devices was approximately 10% but varied by pump type. 28 In addition to pump failure, comorbidities may include right ventricular failure, hepatic or renal dysfunction, a history of prior stroke, and ongoing hemolysis, coagulopathy, and platelet dysfunction. All these comorbidities should be considered when deciding on the operative method of exchange.…”

Repeat left ventricular‐assisted device exchange and upgrade from second‐ to third‐generation devices in a high‐volume single center

“…Especially in the setting of promising 5-year outcomes from the Momentum 3 trial, the exchange and upgrade strategy appear appealing as it offers the opportunity to upgrade to a safer, more hemocompatible device. 2 Prior data established the safety and efficacy of exchange and upgrade procedures, [7][8][9] as well as the feasibility and efficacy of repeat exchanges to treat the above-mentioned complications. [10][11][12] No data have been reported however on the safety and efficacy of concomitant repeat exchange-and-upgrade, with the reintervention being aimed at implanting a different, third-generation pump.…”