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HeartMate 3 in Lowest INTERMACS Profile Cohort: The Swiss Experience

Tozzi, Piergiorgio*; Banfi, Carlo; Ahmadov, Kameran*; Hullin, Roger; Meyer, Philippe§; Giraud, Raphael; Liaudet, Lucas; Gronchi, Fabrizio#; Huber, Christophe; Kirsch, Matthias*

doi: 10.1097/MAT.0000000000000589
Adult Circulatory Support

New generation devices for long-term mechanical circulatory support are centrifugal pumps having fully magnetically levitated rotors to reduce blood trauma. Recently, the novel HeartMate 3 was cleared for clinical application in Switzerland. In two Swiss University Hospitals part of the “Lausanne–Geneva Transplantation Network,” 10 consecutive patients in end-stage heart failure received the HeartMate 3 (Thoratec Corporation, Pleasanton, CA). Device implantation criteria were persistent low output syndrome despite optimal medical treatment. The primary end-point of the study was survival or transplantation to 90 days on the device. Five patients (50%) were in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) class 1 and 2 (two were under venoarterial extracorporeal membrane oxygenation [VA-ECMO]), and five were in class 3 and 4. The indication was bridge-to-transplant in seven patients, and destination therapy in three. Two patients (20%) received concomitant aortic valve surgery. Four patients (40%) required temporary right ventricle support (tRVAD) for a mean of 8 ± 1.5 days. Bleeding requiring surgical revision occurred in five (50%) patients, two during the tRVAD support. At the 90 day end-point, survival was 90%, one (10%) died due to respiratory failure. Three (30%) experienced critical illness polyneuropathy. Two had body temperature over 38.5°C for more than 7 days after implant, without infections. Two (20%) had late driveline infection. The pump allowed rapid improvement of patients’ clinical conditions even in severely compromised patients. Postoperative bleeding occurred in the setting of anticoagulation. No hemolysis or pump thrombosis occurred. Fever occurred frequently but was not associated with mortality. Hemodynamic support was consistent over time without significant adverse events.

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From the *Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Department of Cardiovascular Surgery, Hopitaux Universitaires de Geneve (HUG), Geneva, Switzerland; Department of Cardiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; §Department of Cardiology, Hopitaux Universitaires de Geneve (HUG), Geneve, Switzerland; Department of Intensive Care Unit, Hopitaux Universitaires de Geneve (HUG), Geneva, Switzerland; Department of Intensive Care Unit, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; and #Department of Anesthesiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.

Submitted for consideration December 2016; accepted for publication in revised form April 2017.

Drs. Tozzi and Banfi contributed equally to the article and are considered both as first authors.

Disclosure: The authors have no conflicts of interest to report.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.asaiojournal.com).

Correspondence: Piergiorgio Tozzi, Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerland. Email: Piergiorgio.Tozzi@chuv.ch.

Copyright © 2017 by the American Society for Artificial Internal Organs