Emergency HeartWare-to-HeartMate 3 exchange bridged by ECMO in the management of acute LVAD failure and cardiogenic shock

Abstract Background After the 2021 withdrawal of the HeartWare HVAD System for pump restart failures, the HeartMate 3 became the only available left ventricular assist device for replacement. Case presentation A 66-year-old male with end-stage ischemic heart failure, 8 years post-HVAD implantation, was admitted with sepsis and LVAD thrombosis causing cardiogenic shock managed with VA-ECMO. Persistent thrombosis necessitated emergent surgical intervention. The HVAD was replaced with a HeartMate 3 using the ring-on-ring and glove-gasket technique under CPB via ECMO cannulas. Postoperative recovery was gradual, with significant neurological and functional improvement at 5 months. Conclusions The case illustrates the feasibility of emergent HVAD-to-HM3 exchange supported by VA-ECMO in a patient with cardiogenic shock after LVAD thrombosis.