Perioperative management and outcomes of hip and knee arthroplasty among heartmate 3 left ventricular assist device recipients

PURPOSE: We aimed to evaluate preoperative cardiovascular assessment, perioperative management, and outcomes in HM3 recipients undergoing hip or knee arthroplasty. METHODS: This retrospective case series included six patients with HM3 LVADs undergoing total hip or knee arthroplasty. Mean age was 67.4 ± 5.7 years; two were female, and two had ischemic cardiomyopathy. Average ejection fraction was 15 ± 4.5%. RESULTS: Procedures included three knee arthroplasties (50%), two total hip arthroplasties (33.3%), and one hip hemiarthroplasty (16.7%). Median time from LVAD implantation to arthroplasty was 19.2 ± 13.6 months. Patients were admitted an average of 2.7 ± 1.8 days preoperatively; mean postoperative length of stay was 13 days. All patients were anticoagulated with warfarin (mean INR 1.4 ± 0.2), with five requiring heparin bridging. LVAD-related infections developed in three patients (50%), and two (33%) required readmission. At final follow-up, two patients (33%) had died, at a mean of 28 ± 8 months post-arthroplasty and 47 ± 36 months after HM3 implantation. CONCLUSION: Hip and knee arthroplasty in HM3 LVAD recipients can be performed with perioperative management strategies that mitigate excess mortality beyond expected LVAD outcomes. These findings highlight the importance of specialized perioperative care in improving the safety and feasibility of arthroplasty in HM3 LVAD patients. Larger studies with longer follow-up are needed to refine patient selection, optimize perioperative care, and clarify the value of arthroplasty in this complex population.

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