Removal and Exchange of Durable Mechanical Circulatory Support

The approach to device exchange will depend on the indication for the exchange. Most device exchanges were historically performed from one pump to another pump of the same manufacturer and model. However, as pumps become discontinued, or obsolete, and since the safety recall of HeartWare HVAD pump in 2021, most contemporary exchanges will be to the Heartmate 3, as it is the only commercially available device since 2021. While left ventricular assist devices (LVADs) have revolutionized the treatment of advanced heart failure, there are circumstances that may necessitate the replacement or removal of the device, such as device thrombosis, device failure, or device infection. However, the current evidence does not support an exchange from HVAD to HeartMate 3 without these hard indications. This chapter delves into the various reasons why changing or removing an LVAD might be required. Each indication may have more than one surgical approach for device exchange.