Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

Aditi Nayak; Shelley A Hall; Nir Uriel; Daniel J Goldstein; Joseph C Cleveland Jr; Jennifer A Cowger; Christopher T Salerno; Yoshifumi Naka; Douglas Horstmanshof; Daniel Crandall; AiJia Wang; Mandeep R Mehra

doi:10.1016/j.jacc.2023.05.066

Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

J Am Coll Cardiol. 2023 Aug 29;82(9):771-781. doi: 10.1016/j.jacc.2023.05.066.

Authors

Affiliations

¹ Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
² Baylor University Medical Center, Dallas, Texas, USA.
³ Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA.
⁴ Montefiore Einstein Center for Heart and Vascular Care, New York, New York, USA.
⁵ University of Colorado School of Medicine, Aurora, Colorado, USA.
⁶ Henry Ford Hospitals, Detroit, Michigan, USA.
⁷ University of Chicago Medicine, Chicago, Illinois, USA.
⁸ Weill Cornell Medical College, New York, New York, USA.
⁹ Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA.
¹⁰ Abbott, Abbott Park, Illinois, USA.
¹¹ Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: MMEHRA@BWH.HARVARD.EDU.

PMID: 37612008
DOI: 10.1016/j.jacc.2023.05.066

Abstract

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged.

Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial.

Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years.

Results: Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m² at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]).

Conclusions: Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent. (MOMENTUM 3 IDE Clinical Study Protocol, NCT02224755; MOMENTUM 3 Pivotal Cohort Extended Follow-up PAS, NCT03982979).

Keywords: MOMENTUM 3; advanced heart failure; left ventricular assist device; long-term survival; mechanical circulatory support; predictors of prognosis.

Publication types

Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Coronary Artery Bypass
Female
Heart Failure* / therapy
Heart-Assist Devices*
Hospitalization
Humans
Male
Middle Aged
Patient Discharge

Associated data

ClinicalTrials.gov/NCT03982979
ClinicalTrials.gov/NCT02224755