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Heart Replacement Therapy in Young Patients: A Comparative Analysis of HeartMate 3 LVAD and Heart Transplant Using

Nir Uriel1, Gabriel T Sayer1, Boaz Elad1

  • 1Columbia University Irving Medical Center, New York, New York, USA.

JACC. Heart Failure
|February 7, 2026
PubMed

Insights

For advanced heart failure patients under 50, durable left ventricular assist device (LVAD) therapy shows survival comparable to heart transplantation (HT). This suggests an LVAD-first strategy may be a viable initial heart replacement option.

Area of Science:

  • Cardiology
  • Medical Devices
  • Transplantation Medicine

Background:

  • Younger patients (18-49) with advanced heart failure (HF) face unique challenges with advanced therapies.
  • Heart transplantation (HT) offers good survival but has limited graft longevity.
  • The HeartMate 3 (HM3) left ventricular assist device (LVAD) shows promise, but direct comparisons with HT in this age group are limited.

Purpose of the Study:

  • To compare survival and adverse event (AE) outcomes between younger patients receiving HM3 LVAD support and those listed for or undergoing HT.

Main Methods:

  • Analysis of patients aged 18-49 from the MOMENTUM 3 trial (HM3 cohort, n=420) and UNOS registry (HT listing/recipients, n=1,955).
  • Propensity score matching was used to adjust for baseline differences.
  • Outcomes assessed included 2-year survival, freedom from death/delisting, and 1-year incidence of major AEs (stroke, renal dysfunction, infection).

Main Results:

  • Two-year survival was similar between HM3 and HT (88.7% vs 90.2%).
  • HM3 showed higher freedom from death compared to freedom from death or delisting for deterioration in UNOS (90.1% vs 76.7%).
  • HM3 recipients had lower rates of renal dysfunction (5.0% vs 10.4%) and infection hospitalizations (24.8% vs 34.2%), but a higher incidence of stroke (3.4% vs 0.3%).

Conclusions:

  • Durable LVAD therapy, like HM3, offers survival comparable to HT in adults under 50.
  • These findings support considering an LVAD-first strategy for heart replacement in selected younger patients.
  • HM3 LVAD provides a viable alternative to HT for this demographic.
Abstract

Keywords:
advanced heart failureadverse event(s)heart transplantationleft ventricular assist devicepropensity score matchingsurvival

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