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Comparative Study
. 2025 Jan;169(1):148-159.e3.
doi: 10.1016/j.jtcvs.2023.12.019. Epub 2023 Dec 27.

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

Michael Kirschner  1 , Veli K Topkara  2 , Jocelyn Sun  3 , Paul Kurlansky  4 , Yuji Kaku  1 , Yoshifumi Naka  1 , Melana Yuzefpolskaya  2 , Paolo C Colombo  2 , Gabriel Sayer  2 , Nir Uriel  2 , Koji Takeda  5
Affiliations
Comparative Study

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

Michael Kirschner et al. J Thorac Cardiovasc Surg. 2025 Jan.

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.

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Conflict of interest statement

Conflict of Interest Statement The HeartMate 3 left ventricular assist system is manufactured by Abbott. P.C. serves as an Abbott consultant without honoraria and has received an Abbott research grant. G.S. receives consulting fees from Abbott and Medtronic. N.U. receives grant support from and serves as a consultant for Abbott and Medtronic. Y.N. serves as consultant for Abbott. The other authors have no conflicts of interest to report. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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