Successful HeartMate 3 Decommissioning Following Myocardial Recovery from Chronic Heart Failure

Abstract

Introduction HeartMate 3 (HM3) removal has been reported in <5 cases but to our knowledge decommissioning of this pump has not previously been reported. Here we report the first successful case of HM3 decommissioning after successful myocardial recovery on the HM3 left ventricular assist device (LVAD). Case Report A 24-year-old female underwent HM3 implantation in October 2019 for idiopathic cardiomyopathy resulting in chronic heart failure (EF 10-15%, LVEDD 6.3cm, PCWP 25mmHg, cardiac index 1.3L/min/m2 requiring milrinone). She received our recovery protocol after HM3 implantation (aggressive heart failure medications maximized LVAD unloading and testing of underlying myocardial function) and her LV dimensions reduced and her ejection fraction (LVEF) gradually improved. On low speed echo testing her LVEDD was 3.8cm, LVESD 3.0 cm and EF 55% and so after 632 days of support the decision was made to proceed with HM3 decommissioning. In July 2021 the patient underwent HM3 decommissioning. Through minimally invasive surgery the outflow tract was stapled, the pump turned off, and the distal part of the driveline excised, with no hemodynamic compromised. After a post-operative hospital stay of 24 days she was discharged home with no need for surgical re-intervention. The patient has been followed at the clinic and is now > 3 months post decommissioning with no complications. She is asymptomatic, physically active, back at work full time and swims regularly without complaints. Her kidney and liver function are back to baseline, with most recent serum creatinine <1mg/dL, and normal liver function test. She is tolerating increment doses of pharmacological guideline directed medical therapy. Her more recent LVEDD is 50mm, LVESD 36mm and LVEF is 45%. Anticoagulation has been with warfarin (INR maintained 2-3). To date she has had no arrhythmias or thromboembolic complications. Summary We present the first reported case of HM3 decommissioning and to date the patient reports higher quality of life after decommissioning. This suggests minimally invasive surgical decommissioning of the HM3 is feasible after myocardial recovery.