Hemocompatibility-Related Adverse Events in HeartMate 3 Patients: A Single-Center Experience

Objectives: Left ventricular assist devices (LVAD) are an established treatment option for patients suffering from advanced heart failure. However, the benefit of improved survival and quality of life may be impaired by device- and anticoagulation-related complications (HRAE), such as gastro-intestinal bleeding, stroke or pump thrombosis. We assessed the value of these complications in our HeartMate 3 patient population.

Methods: We analyzed all cases of HeartMate 3 implantations (n = 42) performed in our clinic since November 2015. LVAD implantation was performed according to the ESC Guidelines 2016 for the diagnosis and treatment of acute and chronic heart failure. Anticoagulation was performed as recommended, initially with heparin (partial thromboplastin time: 55–65s) and when the patient is able to take oral medications, with Aspirin (100mg daily) and Phenprocoumon (international normalized ratio: 2–3). We analyzed device- and anticoagulation related complications (HRAE). Hemocompatibility score was calculated as described previously (Mehra MR. The burden of haemocompatibility with left ventricular assist systems. A complex weave. Eur Heart J 2017).

Results: HeartMate 3 was implanted in 42 patients (mean age: 59 ± 11.3 years, male: 39, 93%). In 13 patients the device was implanted as destination therapy, in 22 as a bridge to transplant and in 7 as bridge to decision. Patients' INTERMACS profiles were: 1 (20%), 2 (18%), 3 (30%), 4 (33%). Mean follow up was 275 days (range: 7–675 days) and to 100% complete. Survival at 30-day was 90% and follow up survival rate was 83%. During follow up hemocompatibility-related adverse events (HRAE) occurred in 9 patients (21.4%), 5 (%) underwent resternotomy due to bleeding, one patient (3%) had gastrointestinal bleeding and 2 patients (4.7%) had an embolic stroke immediately after surgery and one patient had (2.4%) cerebral bleeding due to trauma. All patients have no neurological deficiencies. There were no pump thromboses, no further stroke-related neurological events or arterial thromboembolisms. HRAE free survival was 80% at one year.

Conclusion: Our results show favorable hemocompatibility-related outcomes in patients undergoing LVAD implantation using the HeartMate 3 with low incidence gastrointestinal bleeding, stroke and pump thrombosis.