Purpose
The effect of pulmonary hemodynamics on outcomes after the implantation of the HeartMate 3 left ventricular assist device (HM3-LVAD) is still not fully understood, although some studies indicate positive results. We conducted an analysis using the EUROMACS international database, which includes many patients from various sites across Europe.
Methods
We identified adults who underwent HM3-LVAD implantation from the EUROMACS Database of the European Association of Cardiothoracic Surgery from January 2018 through April 2024. We excluded those with previous cardiac surgery, undergoing concomitant cardiac procedures, on an IABP or ECMO, and those with missing hemodynamic data. Based on the pre-transplant hemodynamic profile, patients were categorized into: Group 1 with a mean pulmonary artery PA pressure (mPAP) < 20 mmHg and a pulmonary vascular resistance (PVR) < 2 WU; Group 2 with a mPAP > 20 mmHg and a PVR < 2 WU; and Group 3 with a PVR > 2 WU. We compared 1- and 2-year mortality rates, major bleeding, and right ventricular (RV) failure after adjusting for factors in the HM3 Survival Risk Score.
Results
632 individuals were identified: 47 (7.4%) in group 1, 144 (22.8%) in group 2, and 441 (69.8%) in group 3. Groups differed in age, gender, body mass index, race, and pre-LVAD use of some medications. Post-implant 1-year and 2-year death rates were 14.1% (n=89) and 18.7% (n=118), respectively while 16.0% (n=103) experienced a major bleed. After adjusting for factors in the HM3 Risk Score, no differences were seen in the odds of 1-year death when group 1 (Odds Ratio [OR] 1.09, 95% confidence interval [CI] 0.46-2.59) and group 2 (OR 0.61, 95% CI 0.61-1.86) were compared with group 3 (Figure). Similar results were seen for 2-year mortality (group 1 vs. group 3, p = 0.561; group 2 vs group 3, p = 0.330) and major bleeding (group 1 vs. group 3, p = 0.476; group 2 vs group 3, p = 0.958) with no difference between the groups. While, compared with group 3, group 1 increased the odds of late (>14 days) RV failure, no other differences in late or early (14 days) failure were seen.
Conclusions
In this retrospective study, elevated PA pressure and/or resistance did not affect the mortality and bleeding rates up to 2 years after HM3-LVAD implantation in adults enrolled in the EUROMACS database.
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