HVAD to Heartmate 3 Device Exchange: A Society of Thoracic Surgeons Intermacs Analysis

BACKGROUND On June 3, 2021 Medtronic, Inc announced discontinuation of the HVAD left ventricular assist device. The purpose of this analysis was to provide summary data on surgical risks of HVAD to HeartMate 3 exchange and compare survival after HVAD to HeartMate 3 exchange to survival after primary HVAD implantation. METHODS Three cohorts within The Society of Thoracic Surgeons Intermacs database were identified: primary HVAD implant cohort (January 2017 to March 2021, n = 3797), HVAD to HeartMate 3 exchange cohort (December 2017 to March 2021, n = 45), and HVAD to HVAD exchange cohort (January 2017 to March 2021, n = 234). Mortality after HVAD to HeartMate 3 exchange was modeled and compared with the constant hazard phase for risk of mortality while on continued HVAD support. As a secondary analysis outcomes and survival were compared between patients who un-derwent HVAD to HeartMate 3 and HVAD to HVAD exchange. RESULTS HVAD to HeartMate 3 exchange was associated with significantly reduced survival compared with survival while remaining on HVAD support (6 months after exchange, 73.8% [70% confidence interval, 68.6-77.8] vs 79.0% [70% confidence interval, 78.3-79] for continued HVAD support). Compared with HVAD to HVAD exchange, survival was higher after replacement with HeartMate 3 (1 year: 85.9% [70% confidence interval, 79.5-90.5] vs 66.6% [70% confidence interval, 63.0-70.0], P = .009). CONCLUSIONS Compared with continued support on HVAD, an exchange to HeartMate 3 was found to be associated with a significant increase in mortality. For patients who required pump exchange on HVAD support, exchange to HeartMate 3 demon-strated superior survival. Currently there is insufficient evidence to support elective exchange from an HVAD to HeartMate 3. (Ann Thorac Surg 2022;114:1672-8) (c) 2022 by The Society of Thoracic Surgeons

Automated summary

Exchange from HVAD to HeartMate 3 is associated with increased mortality compared to continued HVAD support, but superior survival compared to HVAD to HVAD exchange. There is currently insufficient evidence to support elective exchange from HVAD to HeartMate 3.