Fully Magnetically Levitated Centrifugal Flow HeartMate 3 Left Ventricular Assist Device – Improved Performance Compared to Previous Axial Flow Device

Eyal Nachum Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Avishay Grupper Department of Cardiology, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Yigal Kassif Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Yedida Shemesh Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Alex Kogan Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Leonid Sternik Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Alex Lippey Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Sergey Preisman Department of Anesthesiology, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Dov Freimark Department of Cardiology, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel Jacob Lavee Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel Aviv University, Ramat Gan, Israel

Background: Left ventricular assist devices (LVAD) are increasingly used in patients with heart failure as bridge to heart transplantation. The recently introduced fully magnetically levitated centrifugal flow pump HeartMate 3 (HM3) was designed to allow smoother operation and to minimize the risk of early and late complications compared to the previously used axial flow or hydrodynamic-levitated centrifugal flow devices.

Objectives: We compared the early outcomes of patients who underwent HeartMate 2 (HM2) and HM3 LVAD implantation in our center.

Methods: Preimplant and implant data and early postoperative clinical outcomes of all patients who underwent implantation of the HM2 and HM3 LVAD in our center were reviewed. Patients with preimplant cardiac surgery, cardiogenic shock, significant pulmonary disease and less than 6 months follow up were excluded.

Results: Of the 76 pts who underwent implantation of the HM2 (43 pts) and HM3 (33 pts) since November 2006, 48 pts (22 HM2 and 26 HM3) were selected for comparison after patients` exclusion. The preimplant data were similar between the groups, except for the INTERMACS level (HM2 vs HM3 : Level 2 – 50 vs 15.4%, p=0.023; Level 3 – 0 vs 30.8%, p=0.014; Level 4 – 50 vs 53.8%, p=NS). There was no significant difference between the groups regarding bypass time. HM3 patients were found to have significantly shorter ventilation time (22.1 vs 53.2 hrs, p=0.029), shorter ICU stay (65 vs 146 hrs, p= 0.002) and shorter hospital stay (13.7 vs 22.3 days, p= 0.004) compared to HM2 pts. HM2 pts were found to have more bleeding episodes requiring surgical intervention than HM3 pts (0% vs 27%, p= 0.018). There was one hospital death in the HM2 group and none in the HM3 group.

Conclusions: Based upon our initial experience, the use of HM3 LVAD is associated with more rapid postoperative recovery compared to HM2 LVAD, and with a lower incidence of postoperative complications.

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Eyal Nachum

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