HeartMate 3 in Pediatric and Complex Populations: Physiologic Rationale, Patient Selection, and Management Strategies

The HeartMate 3 (HM3) left ventricular assist device (LVAD), initially designed for adults, is increasingly utilized in children, small adults, and those with congenital heart disease (CHD), necessitating expanded knowledge and collaborative efforts. This review highlights key physiologic and management considerations for these unique populations. The HM3's magnetic levitation and artificial pulse mitigate thrombotic risk, but understanding the interplay of pump power, flow, and pulsatility index is crucial, particularly in smaller patients due to their unique power-flow dynamics and pressure sensitivities. Preoperative assessment must carefully consider patient size, left ventricle dimensions, and anatomical suitability. Postoperative management requires individualized anticoagulation, secure driveline placement, and optimized pain control, with specific considerations for varying CHD physiologies, such as Fontan circulation. A multidisciplinary approach is paramount in patients with muscular dystrophy, addressing infection risk, respiratory compromise, and quality of life. Successful HM3 implementation requires comprehensive patient/family education, rehabilitation, psychosocial support, and careful device optimization. Continued collaborative real-world data sharing, particularly regarding long-term outcomes, is essential to refine best practices and optimize support for these complex patients.