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

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.