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Published on: July 18, 2014
Comparing 3-year survival and readmissions between HeartMate 3 and heart transplant as primary treatment for advanced
Michael Kirschner1, Veli K Topkara2, Jocelyn Sun3
1Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
Insights
HeartMate 3 (HM3) left ventricular assist device (LVAD) offers comparable 3-year survival to orthotopic heart transplantation (OHT) for advanced heart failure. However, HM3 patients experienced more readmissions compared to OHT recipients.
Area of Science:
- Cardiovascular Medicine
- Transplantation Surgery
- Medical Devices
Background:
- Advanced heart failure necessitates advanced treatment options.
- Left ventricular assist devices (LVADs) and orthotopic heart transplantation (OHT) are primary treatments for advanced heart failure.
- Comparative outcomes between HeartMate 3 (HM3) LVAD and OHT require further investigation.
Purpose of the Study:
- To compare 3-year survival rates between patients receiving the HeartMate 3 (HM3) LVAD and those undergoing orthotopic heart transplantation (OHT).
- To evaluate and compare the rates of all-cause unplanned readmissions between HM3 LVAD and OHT recipients.
- To assess the efficacy of HM3 LVAD versus OHT as primary treatments for advanced heart failure.
Main Methods:
- Retrospective analysis of 381 adult patients treated between January 2014 and March 2021.
- Propensity score matching was employed to minimize confounding variables between HM3 LVAD and OHT cohorts.
- Primary outcome: 3-year survival. Secondary outcome: Mean cumulative all-cause unplanned readmissions.
Main Results:
- No statistically significant difference in 3-year survival was observed between propensity score-matched HM3 (83.7%) and OHT (87.0%) groups.
- In unmatched cohorts, younger patients (18-49 years) showed comparable survival, while older patients (50+ years) had slightly inferior survival with HM3.
- The mean number of 3-year readmissions was significantly higher in the HM3 group (3.89) compared to the OHT group (2.05).
Conclusions:
- The HeartMate 3 (HM3) LVAD may offer comparable 3-year survival to orthotopic heart transplantation (OHT) for selected patients with advanced heart failure.
- HM3 LVAD implantation is associated with a higher incidence of readmissions compared to OHT.
- Further exploratory analysis is warranted to fully elucidate long-term outcomes and patient selection criteria for HM3 LVAD versus OHT.
Objective:
To compare 3-year survival and readmissions of patients who received the HeartMate 3 (HM3) left ventricular assist device (LVAD) or underwent orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure.
Methods:
We retrospectively analyzed 381 adult patients who received an HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT recipients with a prior LVAD were excluded, and HM3 patients were censored at the time of transplant. Cohorts were propensity score-matched to reduce confounding variables. The primary outcome was 3-year survival, and the secondary outcome was mean cumulative all-cause unplanned readmission.
Results:
The study population comprised 185 HM3 patients (49%) and 196 OHT patients (51%), with 104 propensity score-matched patients in each group. After propensity score matching, there was no statistical difference in 3-year survival (83.7% for HM3 vs 87.0% for OHT; P = .91; relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.20). In the unmatched cohorts, patients age 18 to 49 years had comparable survival with HM3 and OHT (96.9% vs 95.9%; N = 91; P = 1.00; RR, 0.92; 95% CI, 0.09-9.78). Patients age 50+ years had slightly inferior survival with HM3 (75.0% vs 83.9%; N = 290; P = .60; RR, 1.51; 95% CI, 0.85-2.68). The mean number of readmissions at 3 years was higher in the HM3 group (3.89 vs 2.05; P < .001).
Conclusions:
This exploratory analysis suggests that for similar patients, HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure but may result in more readmissions.
