A Decade of Durable Mechanical Circulatory Support with HeartMate 3 Across Age Groups in a Single-Center Experience

Long-term real-world data after HeartMate 3 implantation remain limited, particularly regarding age-specific outcomes. We evaluated on-device survival and major adverse events across nearly a decade of experience.

This retrospective single-center study included 215 patients undergoing primary HeartMate 3 implantation between January 2016 and October 2025. On-device mortality was analyzed using Aalen-Johansen cumulative incidence estimates with heart transplantation as a competing event; age-group differences were assessed using Fine-Gray regression. Transplant-censored Kaplan-Meier survival was examined secondarily, and mortality predictors were evaluated using multivariable Cox regression.

Median age was 53 years and median support was 603 days. At data cutoff, 149 patients remained alive on support, eight underwent transplantation, and 58 died on support. At 5 years, the cumulative incidences of on-device death and heart transplantation were 35.3% and 4.1%, respectively, with no significant age-group difference (Fine-Gray global p = 0.088). In the secondary transplant-censored Kaplan-Meier analysis, estimated survival was 87.4% at 30 days, 81.1% at 1 year, and 63.8% at 5 years. Higher preoperative creatinine was associated with mortality (HR, 1.93 per 1-mg/dL increase; 95% CI, 1.07-3.50; p = 0.029). No intrinsic pump thrombosis occurred.

HeartMate 3 provided durable support with favorable long-term survival, although non-pump adverse events remained clinically relevant.