HeartMate 3 Compared to Heart Transplant Outcomes in England

Abstract

Randomized trials have shown better outcomes with HeartMate 3 (HM3) compared to HeartMate 2 left ventricular assist devices (LVADs). This study aims to evaluate the real-world outcomes with HM3 LVADs in England. Funding of LVADs in England is limited to bridge to candidacy or transplantation. HM3 LVADs are implanted in 3 of the 5 LVAD-implanting centres in England (Birmingham, Manchester and Papworth). Consecutive patients with HM3 LVAD from all 3 centres in the England from November 2015 to June 2019 were included. Survival on HM3 was benchmarked against heart transplantation (OHT) at the 3 centres over the same period. We included 167 HM3 patients [TABLE]. Median follow-up was 659 (338-969) days. Eight HM3 patients underwent heart transplantation. Overall survival at 2 years was 87%. 2-year survival on HM3 support was 83%. Severe right heart failure post-LVAD (defined as use of right ventricular assist device support) occurred in 28 patients (17%). 1-year survival was 71% compared to 93% in patients without severe right heart failure (p=0.003 Log rank test). There were no cases of pump changes for pump thrombosis. 2-year survival from HM3 was comparable to 344 contemporaneous patients who underwent OHT (excluding 37 OHT patients bridged with Heartware, Heartmate 2 and Heartmate 3 LVADs) FIGURE], despite younger age of OHT patients (50 (38-59) years, p<0.001). 2-year survival on HM3 LVAD support in England is comparable to published studies and comparable to heart transplantation.