Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device

Area of Science:

• Cardiology
• Medical Devices
• Clinical Trials

Background:

• Prior analyses indicate a correlation between smaller left ventricular end-diastolic diameter (LVEDD) and reduced survival after HeartMate 3 left ventricular assist device (LVAD) implantation.
• This study investigates the clinical characteristics and outcomes associated with a smaller LVEDD in patients receiving HeartMate 3 LVADs.

Purpose of the Study:

• To comprehensively analyze the relationship between a smaller LVEDD (<55 mm) and patient outcomes in the MOMENTUM 3 trial.
• To identify clinical characteristics associated with a smaller LVEDD and its impact on survival and adverse events at 2 years post-LVAD implantation.

Main Methods:

• Analysis of 1,921 HeartMate 3 patients from the MOMENTUM 3 trial, categorizing them by LVEDD (<55 mm vs. ≥55 mm).
• Evaluation of overall survival and adverse events, including hemocompatibility-related (stroke, bleeding, pump thrombosis) and non-hemocompatibility-related (right heart failure, infection) outcomes at 2 years.
• Statistical analysis to compare outcomes between the two LVEDD groups.

Main Results:

• Patients with LVEDD <55 mm were older, more frequently female, and had a higher prevalence of ischemic cardiomyopathy.
• The LVEDD <55 mm group exhibited higher in-hospital mortality (14.8% vs. 5.7%) and lower 2-year survival (63.3% vs. 81.8%).
• Increased deaths due to hemocompatibility issues and right heart failure (both early and late) were observed in the smaller LVEDD group, along with higher rehospitalizations for low-flow alarms.

Conclusions:

• A smaller LVEDD (<55 mm) is associated with increased early and late mortality, primarily driven by hemocompatibility-related deaths and right heart failure.
• Rehospitalizations due to low-flow alarms are more frequent in patients with smaller LVEDD.
• These findings underscore the prognostic significance of LVEDD in HeartMate 3 LVAD recipients.