Gender difference and outcomes in HeartMate 3 left ventricular assist device support: Results from the J-MACS...

Analyses of extensive registries in the USA and Europe have revealed poorer clinical outcomes in women following durable left ventricular assist device (LVAD) implantation. The negative impact on mortality after LVAD implantation in women might predominantly come from their small body surface area. The gender-specific prognostic implications of the contemporary fully magnetically levitated LVAD, HeartMate 3 (Abbott, Abbott Park, IL, USA), especially in Japanese cohorts having smaller physiques than Western countries, remain unclear.

Patients with advanced heart failure who underwent HeartMate 3 LVAD implantation between 2019 and 2023 and were prospectively registered in the Japanese Registry for Mechanically Assisted Circulatory Support were included. Cumulative mortality, changes in New York Heart Association (NYHA) functional class, and adverse events leading to rehospitalization were retrospectively compared between genders.

A total of 465 patients who received HeartMate 3 implantation (median age: 50 years; women: 26.5 %) were analyzed. The median index hospital stay was longer for women than for men (85 days versus 75 days, p = 0.030). There was no significant difference in cumulative mortality between genders during a median follow-up of 964 days (p = 0.499). Transitions in NYHA functional class were comparable for both genders. However, women exhibited a higher risk of rehospitalization due to major bleeding events, with an adjusted hazard ratio of 3.343 (95 % confidence interval: 1.225-10.018, p = 0.031).

Although women demonstrated an increased risk of major bleeding requiring hospitalization, this did not affect overall mortality following HeartMate 3 implantation. Further studies are warranted to elucidate the mechanisms underlying the heightened rehospitalization risk for major bleeding in women.