Comparing 3-year survival and readmissions between HeartMate 3 and heart transplant as primary treatment for advanced heart failure

Michael Kirschner; Veli K Topkara; Jocelyn Sun; Paul Kurlansky; Yuji Kaku; Yoshifumi Naka; Melana Yuzefpolskaya; Paolo C Colombo; Gabriel Sayer; Nir Uriel; Koji Takeda

doi:10.1016/j.jtcvs.2023.12.019

Comparing 3-year survival and readmissions between HeartMate 3 and heart transplant as primary treatment for advanced heart failure

J Thorac Cardiovasc Surg. 2023 Dec 27:S0022-5223(23)01207-2. doi: 10.1016/j.jtcvs.2023.12.019. Online ahead of print.

Authors

Affiliations

¹ Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY.
² Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY.
³ Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY.
⁴ Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY; Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Irving Medical Center, New York, NY.
⁵ Division of Cardiac, Thoracic & Vascular Surgery, Department of Surgery, Columbia University Irving Medical Center, New York, NY. Electronic address: kt2485@cumc.columbia.edu.

PMID: 38154500
DOI: 10.1016/j.jtcvs.2023.12.019

Abstract

Objective: To compare 3-year survival and readmissions of patients who received the HeartMate 3 (HM3) left ventricular assist device (LVAD) or underwent orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure.

Methods: We retrospectively analyzed 381 adult patients who received an HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT recipients with a prior LVAD were excluded, and HM3 patients were censored at the time of transplant. Cohorts were propensity score-matched to reduce confounding variables. The primary outcome was 3-year survival, and the secondary outcome was mean cumulative all-cause unplanned readmission.

Results: The study population comprised 185 HM3 patients (49%) and 196 OHT patients (51%), with 104 propensity score-matched patients in each group. After propensity score matching, there was no statistical difference in 3-year survival (83.7% for HM3 vs 87.0% for OHT; P = .91; relative risk [RR], 1.00; 95% confidence interval [CI], 0.45-2.20). In the unmatched cohorts, patients age 18 to 49 years had comparable survival with HM3 and OHT (96.9% vs 95.9%; N = 91; P = 1.00; RR, 0.92; 95% CI, 0.09-9.78). Patients age 50+ years had slightly inferior survival with HM3 (75.0% vs 83.9%; N = 290; P = .60; RR, 1.51; 95% CI, 0.85-2.68). The mean number of readmissions at 3 years was higher in the HM3 group (3.89 vs 2.05; P < .001).

Conclusions: This exploratory analysis suggests that for similar patients, HM3 may provide comparable 3-year survival to OHT as a primary treatment for heart failure but may result in more readmissions.

Keywords: age; heart transplant; left ventricular assist device; readmissions; survival.