Outcomes over One and a Half Decade Following HeartMate II versus HeartMate 3 Left Ventricular Assist Device Therapy: The Rotterdam Experience

Abstract

<h3>Purpose</h3> Continuous-flow left ventricular assist device (LVAD) therapy has become an indispensable treatment modality for patient with end-stage heart failure. Therefore, our aim is to evaluate our results with 2 contemporary generations of the mainstream LVAD device types, being the HeartMate II (HMII) and HeartMate 3 (HM3), with over one and a half decade of experience, in the treatment of end-stage heart failure patients within our tertiary referral center. <h3>Methods</h3> We included all adult patients implanted with an LVAD from December 2006 until December 2019. The primary outcome was early and late survival. Secondary outcomes included multiple adverse events, both early and late. <h3>Results</h3> In total, 133 patients (mean age 56 ± 12 year, 77% male) underwent implantation of an LVAD: 64 (48%) received an HMII and 69 (52%) received an HM3, with a median follow-up period of 768 days [IQR 221-1206] and 427 days [IQR 269 - 962], respectively. The HM3 patients were compared to the HM II group older (57 ±10 vs 49±12), had a higher median body mass index (25.6 [IQR 22.5-28.1] vs 22.8 [IQR 20.7-25.1]) and less frequently implanted as bridge-to-transplant (26 (30%) vs 61 (70%)). However, despite the increased age and rate of morbidity, survival (both early and late) were similar for both patient groups, as displayed in the <b>Figure</b>. Furthermore, bleeding events, rates of stroke, re-thoracotomy rates, and confirmed pump-thrombosis rates did not differ between both groups. <h3>Conclusion</h3> Despite the older age and relatively higher risk profile of the second era HM 3 patients compared with the HM II patients, the rate of adverse events did not differ between both groups. Similarly, the survival remains favorable regardless of a lower transplantation rate and higher destination therapy strategy in the HM3 group. Therefore, LVAD therapy remains an excellent modality to improve both the quality of life and survival in a broad range of end-stage heart failure patients.