Outcomes in Patients with Smaller Left Ventricular End Diastolic Diameter Following HeartMate 3 (HM3) Left Ventricular Assist Device (LVAD) Implantation

Abstract

Outcomes in patients with small left ventricular end diastolic diameter (LVEDD) following HM3 LVAD implantation have not been well characterized. We sought to compare the clinical outcomes of patients with small LVEDD to those with dilated left ventricles. Patients who received a HeartMate 3 LVAD at our institution between October 1, 2015 and June 30, 2019 were analyzed. Patients who received a HM3 LVAD as a pump exchange were excluded. The cohort was divided in 2 groups: smaller LVEDD (≤60 mm in males and ≤58 mm in females) and larger LVEDD (>60 mm in males and >58 mm in females). One hundred and nineteen patients underwent HeartMate 3 LVAD implantation at our institution. Patients in the smaller LVEDD group (n: 22) had a mean LVEDD of 55.7±5 mm and patients in the larger LVEDD group had a mean LVEDD of 70.6±8 mm (p=<0.0001). Patients in the smaller LVEDD group tended to be older (60±11 vs 56±11 years, p=0.07), and included more males (82% vs. 68%, p=0.3) and fewer African-Americans (59% vs. 79%, p=0.08). Patients in the smaller LVEDD group were more likely to have a history of ischemic cardiomyopathy (50% vs. 23%, p=0.01), CAD (82% vs. 30%, p<0.001)) and diabetes (73% vs. 47%, p=0.03). INTERMACS class 1 + 2 was similar between groups (72% vs. 68%, p=0.9). Mean days on the ventilator (2.4±3 vs. 3.2±5 days, p=0.5), on inotropes (16±12 vs. 15±8 days, p=0.69) and vasopressors (9±9 vs. 7±11 days, p=0.6) was similar between groups. Mean length of stay (25±14 vs. 29±17 days, p=0.2) and readmissions days (25±52 vs. 27±46 days, p=0.8) were also similar. One-year survival was 90% for the smaller LVEDD group and 95% for the larger LVEDD group (Figure, log rank 0.696). Adult patients with smaller LVEDD who received a HeartMate 3 LVAD have comparable clinical outcomes to patients with larger LVEDD. A small left ventricle should not be a contraindication to implantation of this particular durable device in adult patients.