Greater Left Ventricular Remodeling in Patients with Heartmate 3 Support is Associated with Fewer Heart Failure Readmissions, Gastrointestinal Bleeding and Renal Failure

Abstract

Purpose While pump thrombosis was markedly reduced with HeartMate 3, other clinical outcomes that impact patient morbidity such as heart failure hospitalization (HFH), gastrointestinal bleeding (GIB) and renal failure remain prevalent. This study aims to explore the association between left ventricular (LV) remodeling and these clinical outcomes. We postulate that a greater reduction in LV end-diastolic diameter (LVEDD) would be associated with greater LV unloading and fewer adverse events. Methods Data on demographics, pre/post-implant LVEDD, and clinical outcomes were retrospectively analyzed in patients with HeartMate 3 implant at our institution from 01/2015-01/2020. The primary composite outcome was HFH, GIB and renal failure requiring dialysis (RRT) at 6 months post-implant. Descriptive statistics are reported. Results 201 patients with HeartMate 3 implant (mean age 58 ± 12 years, 56% destination therapy) had median 9.9 [6, 17] months follow-up. Most were Caucasian (79%) males (77%), with ischemic cardiomyopathy (91%). Arrhythmia (62%), dyslipidemia (55%) and hypertension (53%) were common comorbidities. Overall 23 patients died. The 6-month composite outcome of HFH, GIB and RRT was 35%. A decrease of median 9 [4, 16] mm was noted in post-implant LVEDD from baseline. A reduction in LVEDD of 30% occurred in 138, 47, and 11 patients, respectively. A reduction of Conclusion LVEDD size reduction ≥15% from baseline is associated with improved clinical outcomes. Future studies are warranted to validate these findings, and to understand how to best optimize adequate LV unloading leading to such positive LV remodeling.