Pregnancy and Delivery Care for a Patient With a HeartMate 3.

Abstract

BackgroundThe limited available data on pregnancies among patients with left ventricular assist devices (LVADs) in situ shows elevated rates of maternal and fetal/neonatal morbidity and mortality. The first fully magnetically levitated device providing centrifugal continuous flow, HeartMate 3 (HM3, Abbott), is the only LVAD available in the United States since 2018 and has fewer adverse patient outcomes compared with previous devices.Case summaryA 32-year-old G5P2113 woman became pregnant 19 months after destination-therapy HM3 LVAD placement. Uncomplicated antepartum care and a cesarean delivery at 34 weeks under neuraxial anesthesia was facilitated by our institution's pregnancy heart team.DiscussionThis represents the second reported HM3-supported pregnancy resulting in a live birth. Various barriers to care guided a shared anticoagulation plan, and no hemorrhagic or thrombotic complications occurred. Our intrapartum monitoring strategy facilitated a patient-centered delivery and postpartum experience while maintaining excellent patient safety.