Related Experiment Video

Updated: Jun 10, 2026

Implantation of the Syncardia Total Artificial Heart
16:11

Implantation of the Syncardia Total Artificial Heart

Published on: July 18, 2014

Survival Outcomes in Middle-Aged and Older Patients With Advanced Heart Failure: A Propensity-Matched Analysis of

Nir Uriel1, Gabriel T Sayer1, Paolo C Colombo1

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

JACC. Heart Failure
|June 9, 2026
PubMed

Insights

Heart transplantation (HT) shows higher survival post-procedure than HeartMate 3 (HM3) left ventricular assist device (LVAD) use. However, HM3 offers better survival when accounting for HT waitlist time, especially in middle-aged patients with advanced heart failure.

Area of Science:

  • Cardiology
  • Medical Devices
  • Transplantation Medicine

Background:

  • Heart failure (HF) prevalence increases with age, necessitating advanced treatment options.
  • Left ventricular assist devices (LVADs) and heart transplantation (HT) improve survival and quality of life in advanced HF.
  • Optimal therapy comparison between LVADs and HT in older adults remains controversial.

Purpose of the Study:

  • To compare survival and adverse events in middle-aged and older adults with advanced HF.
  • To evaluate outcomes for patients receiving the HeartMate 3 (HM3) LVAD versus those listed for or undergoing HT.

Main Methods:

  • Analysis of 1,763 patients from the MOMENTUM 3 HM3 cohort and 5,336 from the UNOS registry (2014-2018).
  • Propensity score matching was used to adjust for baseline differences between groups.
  • Outcomes assessed included 2-year survival and 1-year major adverse events (stroke, renal dysfunction, infection).

Main Results:

  • Heart transplantation (HT) showed higher 2-year survival post-treatment compared to HM3 LVAD use in both middle-aged and older groups.
  • When including pre-HT waitlist time, HM3 demonstrated superior survival compared to survival free from delisting due to deterioration in middle-aged HT candidates.
  • For older adults, HM3 survival was numerically higher than HT candidates when waitlist time was considered (76.6% vs 72.2%).

Conclusions:

  • While HT offers better immediate post-treatment survival, HM3 LVAD therapy provides comparable or superior survival when pre-transplant waitlist time is factored in.
  • The findings highlight the critical importance of considering waitlist duration when discussing advanced heart failure treatment strategies.
  • HM3 LVAD therapy is a viable alternative to HT, particularly for patients facing long waitlist periods.
Abstract

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

More Related Videos

Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment08:49

Cardiac Loading using Passive Left Atrial Pressurization and Passive Afterload for Graft Assessment

Published on: August 2, 2024

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Related Concept Videos

Cardiomyopathy V: Interprofessional Care01:29

Cardiomyopathy V: Interprofessional Care

Managing cardiomyopathy involves addressing underlying or precipitating causes, treating heart failure with medications, and implementing dietary changes and a balanced exercise and rest regimen.Lifestyle ModificationsCardiomyopathy patients should adopt a low-sodium diet to reduce fluid retention and manage heart failure. A personalized exercise and rest plan helps maintain physical fitness without overstraining the heart. Avoiding alcohol and tobacco is essential to prevent further damage to...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
Heart Failure III: Clinical Manifestations01:26

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
Cardiomyopathy II: Dilated Cardiomyopathy01:30

Cardiomyopathy II: Dilated Cardiomyopathy

Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...