Repeat Lvad Exchange And Upgrade From Second To Third Generation Devices In A High-volume Single Center

Background Pump exchange is an established strategy to treat LVAD related complications such as thrombosis, infection and driveline failure, even in the setting repeated procedures. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of patient on long term support. Safety and efficacy of a repeat LVAD exchange with concomitant upgrade to a third generation pump has not been reported Methods We performed a retrospective analysis of all consecutive patients who underwent a repeat LVAD device exchange and upgrade to HeartMate III (HMIII) at Houston Methodist Hospital between December 2018 and December 2020. Results Five patient underwent a repeat exchange and upgrade to HMIII within the specified timeframe. Four patients had already had 2 prior exchanges (all HMII to HMII), one patient had 1 prior exchange (HVAD to HVAD). In all cases, implantation was performed as a destination therapy. Surgical exchange was performed via re-do median sternotomy on full cardiopulmonary bypass. No unplanned redo surgery or repositioning of the device component was required. In hospital mortality was 20% in this very high risk population. At 1, 3 and 6 months follow up, all discharged patients were on HMIII support, with no major LVAD related adverse events reported (infection, pump thrombosis, driveline failure). Conclusion We report the feasibility and safety of a repeat pump exchange with upgrade to HMIII in a large volume center. The decision for medical therapy versus surgical exchange has to be tailored to individual cases based on risk factors and clinical stability but in expert hands, even a re-redo surgical approach with upgrade appears to be feasible and granting options for good medium term outcomes. Pump exchange is an established strategy to treat LVAD related complications such as thrombosis, infection and driveline failure, even in the setting repeated procedures. Pump upgrades with an exchange to newer generation devices are being performed to the advantage of patient on long term support. Safety and efficacy of a repeat LVAD exchange with concomitant upgrade to a third generation pump has not been reported We performed a retrospective analysis of all consecutive patients who underwent a repeat LVAD device exchange and upgrade to HeartMate III (HMIII) at Houston Methodist Hospital between December 2018 and December 2020. Five patient underwent a repeat exchange and upgrade to HMIII within the specified timeframe. Four patients had already had 2 prior exchanges (all HMII to HMII), one patient had 1 prior exchange (HVAD to HVAD). In all cases, implantation was performed as a destination therapy. Surgical exchange was performed via re-do median sternotomy on full cardiopulmonary bypass. No unplanned redo surgery or repositioning of the device component was required. In hospital mortality was 20% in this very high risk population. At 1, 3 and 6 months follow up, all discharged patients were on HMIII support, with no major LVAD related adverse events reported (infection, pump thrombosis, driveline failure). We report the feasibility and safety of a repeat pump exchange with upgrade to HMIII in a large volume center. The decision for medical therapy versus surgical exchange has to be tailored to individual cases based on risk factors and clinical stability but in expert hands, even a re-redo surgical approach with upgrade appears to be feasible and granting options for good medium term outcomes.