Clinical Hemodynamic Evaluation of Patients Implanted with a Fully Magnetically Levitated Left Ventricular Assist Device (HeartMate 3)

Introduction The HeartMate 3 (HM 3) is a Conformiteé Européenne (CE) mark approved Left Ventricular Assist Device (LVAD) with a fully magnetically levitated motor whose features include a wide range of operational speeds, wide flow paths and an artificial pulse. Purpose We performed a hemodynamic and echocardiographic evaluation of patients implanted with the HM3 LVAD in order to assess the speed range for optimal hemodynamic support. Methods HM 3 patients underwent pump speed ramp tests with right heart catheterization (including CVP, PAP, PCWP and BP) and 3D echocardiography (3DE). Data were recorded at up to 13 speed settings. Speed changes were in steps of 100 RPMs, starting at 4600 RPMs ramping up to 6200 RPMs. Results Mean original speed was 5306 ± 148 RPM, with a majority of patients (10/16, 62.5%) having normal CVPs and PCWPs at their original RPM settings. Going from lowest to highest speeds, CO improved at the rate of 0.08±0.08 L/min/100 RPMs (total change, 1.25±1.20 L/min) and PCWP decreased at the rate of -0.48±0.27 mmHg/100 RPMs (total change, -6.13±3.72 mmHg). CVP and systolic blood pressure did not change significantly with changes in RPMs. LVEDD decreased at a rate of -0.15±0.09 cm /100 RPMs. RPMs were adjusted based on test results to achieve CVPs and PCWPs as close to normal limits as possible, which was feasible in 13 (81.3%) of patients. For the remaining 3 patients, medical management was pursued in order to optimize hemodynamic support. Conclusion Hemodynamic normalization of pressures was achieved in the majority of patients implanted with the HM 3 pump within a narrow speed range. Unstructured Abstract We prospectively evaluated 16 stable outpatients supported with HM 3, using a ramp study combining invasive hemodynamics and echocardiography. Ten (62.5 %) patients had normal filling pressures at their baseline speed. With increasing speeds, cardiac output increased and pulmonary capillary wedge pressure decreased, while central venous pressure remained unchanged. Left ventricular end diastolic dimension decreased consistently during the ramp study. Based on the test results, filling pressures could be normalized in 13 (81.3 %) of patients within a narrow speed range.