Sex Differences in Characteristics and Outcomes Following HeartMate 3 Left Ventricular Assist Device Implantation

Abstract

In addition to goal-directed therapies, advanced therapies for heart failure including left ventricular assist devices (LVADs) remain underutilized in women. Sex-specific data in the area of mechanical circulatory support remains sparse and women are often underrepresented in heart failure trials. Even less is known about sex differences in outcomes with the HeartMate 3 LVAD, an FDA approved centrifugal-flow device. Consecutive patients who received HeartMate 3 LVAD as bridge-to-transplant or destination therapy at a single institution were included in the study. Demographics, co-morbidities, device-related factors, and outcomes were comparatively examined between women and men. 175 patients (28 women, 16.0%) were identified. Women were significantly younger than men (53.9 vs. 60.1 years, p=0.023) with smaller body surface area (1.83 vs 2.08, p <0.001). Women were less likely to have hypertension (42.9% vs 64.6%, p=0.030), to use tobacco (35.7% vs 57.5%, p=0.034), and to have an ischemic etiology of HF (21.4% vs 52.4%, p=0.003). There were no differences in the use of temporary mechanical circulatory support and INTERMACS profiles. There were similar rates of RVAD use (35.7% vs. 30.6%, p=0.594) and continuous veno-venous hemofiltration (10.7% vs 8.2%, p=0.659) in women and men. There were no differences in in-hospital mortality (3.7% vs 6.3%, p=0.595) or 90-day mortality (8.7% vs 6.9%, p=0.762) between women and men. There was no difference in post-implant survival (82.8% vs 87.7%, log-rank p=0.944) [Figure], freedom from gastrointestinal bleeding (70.5% vs 69.1%, log-rank p =0.278) or freedom from stroke (96.4% vs 91.4%, log-rank p = 0.471) at 2-year follow-up between women and men. In our single-center experience with HeartMate 3 LVADs, there were no significant differences in early morbidity and mortality between women and men.