Vol. 20 JA2016 - cardiac

C-10 – First series of circulatory support with HeartMate 3®: report of referral institutions experience

novembre 29, 2016
Auteur correspondant : Matthias Kirsch

Matthias Kirsch1, Piergiorgio Tozzi1, Carlo Banfi2, Kamran Ahmadov1, Roger Hullin3, Philippe Meyer4, Raphaël Giraud5, Lucas Liaudet6, Fabrizio Gronchi7, Christophe Ellenberger8, Christophe Huber2

Institutions :
1. Service de chirurgie cardiaque, CHUV, Lausanne, Suisse
2. Service de chirurgie cardiovasculaire, HUG, Genève, Suisse
3. Service de cardiologie, CHUV, Lausanne, Suisse
4. Service de cardiologie, HUG, Genève, Suisse
5. Service de soins intensifs, HUG, Genève, Suisse
6. Service de soins intensifs, CHUV, Lausanne, Suisse
7. Service d’anesthésie, CHUV, Lausanne, Suisse
8. Service d’anesthésiologie, HUG, Genève, Suisse

Objectives : 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.

Methods : In 2 Swiss University Hospitals, 10 patients in end-stage heart failure received the HeartMate 3®. Device implantation criteria were persistent low output syndrome despite optimal medical treatment. The primary endpoint of the study was survival to 90 days on the device.

Results : Five patients (50%) were in INTERMACS class 1 and 2 (2 were under V-A ECMO), and five were in class 3 and 4. The indication was bridge-to-transplant in 7 patients, and destination therapy in 3. 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 5 (50%) patients, 2 during the tRVAD support. At the 90-day endpoint 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.

Conclusion : The pump allowed rapid improvement of patients’ clinical conditions even in severely compromised patients. Post-operative bleeding was mainly due to over-anticoagulation. No haemolysis or pump thrombosis occurred. Fever occurred frequently but was harmless. The 90% survival rate at 90 days proves that hemodynamic support was consistent over time without significant adverse events.