Thumbs up for HeartMate 3 in cohorts with high perioperative risk

The HeartMate 3 left ventricular assist device (LVAD) can offer a lifeline to patients with severe heart failure, including those with morbid obesity and advanced chronic kidney disease (CKD), medical conditions that carry increased perioperative risks, as suggested in a retrospective cohort study.

In a cohort of 193 patients who received a HeartMate 3 LVAD, “we found no significant difference in any measured outcomes for severely obese patients and those with stage 4 or 5 CKD when compared with controls,” according to first study author Dr Benjamin French from the Emory University School of Medicine in Atlanta, Georgia, US.

Patients with morbid obesity

Of the patients, 27 had an average BMI of 45.0 kg/m² and 166 had a BMI of <40 kg/m² (control). Survival was similar between the two patient groups at the following timepoints: 30 days (p=0.3), 1 year (p=0.8), and 2 years (p=0.9). [HFSA 2024, poster 4145193;012]

The length of ICU stay after implantation was 10.1 days in the severely obese group vs 11.6 days in the control group (p=0.5), and the length of total hospitalization was 22.9 vs 24.2 days, respectively (p=0.7). Patients in the severely obese group were readmitted 1.6 times per year, while those in the control group were readmitted 1.9 times per year (p=0.5).

Finally, the incidence of new driveline infections at 2 years after implantation did not significantly differ between the two groups (p=0.14).

Patients with advanced CKD

French and colleagues looked at patients with advanced CKD, which was defined based on eGFR levels measured on the morning of LVAD implantation. Of the patients, 157 had eGFR ≥30 mL/min/1.73 m² (stage 4-5 CKD) and 36 had eGFR ≤29 mL/min/1.73 m² (control).

The 30-day mortality was similar between the stage 4-5 CKD and control groups (p=0.1), as was mortality at 1 year (p=1) and 2 years (p=0.5). [HFSA 2024, poster 4145394;214]

The length of ICU stay postimplantation was 13.5 days in the stage 4-5 CKD group vs 10.3 days in the control group (p=0.2), and the length of total hospitalization was 25.8 vs 23.7 days, respectively (p=0.5). Patients with advanced CKD were readmitted 1.47 times per year, while those in the control group were readmitted 1.92 times per year (p=0.3).

Lifesaving therapy

“LVADs are a lifesaving therapy for patients with severe heart failure. The only currently commercially available LVAD is the HeartMate 3, which features an intrathoracic, fully magnetically levitated, centrifugal-flow pump. Currently, there is minimal evidence on the effectiveness of the HeartMate 3 in patients with class III obesity and those with advanced CKD,” French noted.

He emphasized that the findings from the subgroup analyses indicate that HeartMate 3 should be considered in all patients with morbid obesity who have no contraindications to LVAD implantation and that stage 4-5 CKD should not be regarded as a contraindication to device implantation.

The study was limited by its retrospective nature, use of data from a single medical centre, and the relatively small sample size. French acknowledged that while the patients included in the study were primarily admitted or transferred to their institution, some admissions may have possibly occurred outside their system and were not accounted for in the readmission data.