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

OBJECTIVE:Our objective was to compare 3-year survival and readmissions of patients who received HeartMate 3 (HM3) left ventricular assist device (LVAD) or orthotopic heart transplantation (OHT) as primary treatment for advanced heart failure. METHODS:We retrospectively analyzed 381 adult patients who received HM3 LVAD or were listed for OHT between January 2014 and March 2021 at our center. To minimize crossover bias, OHT patients with prior LVAD were excluded and HM3 patients were censored at time of transplant. Cohorts were propensity score-matched (PSM) to reduce confounding variables. Primary outcome was 3-year survival. Secondary outcome was mean cumulative, all-cause, unplanned readmission. RESULTS:Cohorts consisted of 185 (49%) HM3 patients and 196 (51%) OHT patients, with 104 PSM patients in each group. After PSM, there was no statistical difference in 3-year survival (HM3 83.7% vs. OHT 87.0%, P = 0.91; RR = 1.00, 95% CI = 0.45-2.20). In unmatched cohorts, patients ages 18-49 had comparable survival with HM3 as with OHT (96.9% vs 95.9%, N = 91, P = 1.00; RR = 0.92, 95% CI = [0.09-9.78]); patients ages 50+ had similar with HM3, despite an 8.9% difference (75.0% vs 83.9%, N = 290, P = 0.60; RR = 1.51, 95% CI = [0.85-2.68]). Mean cumulative readmissions at 3-years was higher in the HM3 cohort (3.89 vs. 2.05, P < 0.001). CONCLUSION: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.