Real-world clinical and echocardiographic outcomes of HeartMate 3 LVAD: insights from a single center study

Background and Purpose

Given the limited data available relating to the real life, the study aims to evaluate long-term clinical and echocardiographic outcomes in a real-world cohort of patients undergoing HeartMate 3 left ventricular assist device (LVAD) implantation, and to identify potential predictors of adverse events.

Methods

The study retrospectively analyzed 33 consecutive patients who were implanted with HeartMate 3 LVAD at an Italian University Hospital between 2018 and August 2025. Pre- and postoperative adverse events and echocardiographic and survival data were collected. Kaplan–Meier method and logistic regression were used to assess survival rates and outcomes’ predictors.

Results

Mean age was 65.7 ± 4.5 years (88.2% male, 50% with ischemic cardiomyopathy). 63.5% of patients were in INTERMACS Profile 1–3. Mean right ventricular fractional area change was 40 ± 6.5 %, while mean left ventricular ejection fraction was 21 ± 4.5 %. During the median intensive care unit stay (10 (interquartile range 5 - 20) days), the most common postoperative complications (also main causes of death) included thoracic bleeding (35.3%), infections (20.6%), and ischemic stroke (8.8%).

Two-year survival was 68.4% (75% after 1 year), fairly like the existing reports, despite the older age, greater morbidity, and higher percentage of destination therapy (67.6%) in the study population. The overall mean survival time was 57.8 months. During the 34 months median follow-up of selected patients, 14.3% underwent heart transplantation; driveline infections (47.6%) and moderate-severe aortic regurgitation (35.3%) were the most frequent complications, while only 9.5% of patients experienced late right heart failure (HF), also related to careful pre-implant selection. No significant predictors of aortic insufficiency or major bleeding were identified.

Conclusions

The study confirms remarkable long-term outcomes in a real-world HeartMate 3 population from a medium volume center. Good long-term survival, no device thrombosis and low-rate right HF were documented, despite the novel advanced age and the high percentage of destination therapy LVADs.Graphical AbstractFor image description, please refer to the figure legend and surrounding text.