BACKGROUND: Contemporary continuous-flow left ventricular assist devices (CF-LVADs) are associated with degradation of von Willebrand factor (vWF) high-molecular-weight multimers (HMWMs), a critical factor supporting platelet function. We hypothesized that the HeartMate 3 fully magnetically levitated LVAD, designed to reduce circulatory shear stress, favorably influences these hemostatic parameters. METHODS: Fifteen consecutive HeartMate 3 LVAD patients were compared with 11 consecutive HeartMate II controls. Serial plasma samples were collected pre-implant and on Days 2, 7, 30 and 45 post-operatively. Changes in vWF HMWMs were evaluated by 2 independent, study-blind hematologists and confirmed using densitometry-based computerized software. Ristocetin cofactor (RiCO) and vWF antigen (vWF Ag) were measured using standard protocols with enzyme-linked immunosorbent assay. RESULTS: HeartMate 3 patients and HeartMate II controls had a mean age of 67.3 ± 1.4 and 52.8 ± 2.5 years, respectively (INTERMACS Profiles 2 to 4 in 93.3% and 91%, respectively). HeartMate 3 group demonstrated a significantly greater preservation of HMWMs compared with the HeartMate II group, with the most prominent decrease occurring by Day 2 post-operatively and sustained through 45 days (71.94% vs 31.16%, p = 0.001). Laboratory values (normalized to baseline) for RiCO activity, vWF Ag and RiCO:vWF Ag ratio remained in the functional range with no statistically significant differences observed between groups. CONCLUSION: The HeartMate 3 LVAD is associated with enhanced hemocompatibility compared with the HeartMate II LVAD, as demonstrated by the improved preservation of vWF HMWMs, In contrast, effects on HMWM degradation appeared to be dissociated from functional attributes. Further confirmation of these findings in randomized clinical trials is warranted.

Department of Cardiac Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiac Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic; 2nd Department of Surgery 1st Faculty of Medicine Charles University of Prague Prague Czech Republic

Department of Cardiac Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic; 3rd Faculty of Medicine Charles University of Prague Czech Republic

Department of Hematology Brigham and Women's Hospital Boston Massachusetts USA

Heart and Vascular Center Brigham and Women's Hospital and Harvard Medical School Boston Massachusetts USA

Laboratory Methods Institute for Clinical and Experimental Medicine Prague Czech Republic

NRL for Hemostasis Institute of Hematology and Blood Transfusion Prague Czech Republic

St Jude Medical Minneapolis Minnesota USA

Thrombotic Centre and Central Hematology Laboratory Institute of Medical Biochemistry and Laboratory Diagnostics of the General University Hospital and 1st Faculty of Medicine of Charles University of Prague Prague Czech Republic

J Heart Lung Transplant. 2016 Jul;35(7):857-9. doi: 10.1016/j.healun.2016.06.007. PubMed

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