Mid-Term Comparison of Clinical Outcomes Between Continuous-Flow Left Ventricular Assist Devices

Background: Continuous-flow left ventricular assist devices (cf-LVADs) are increasingly applied in patients with advanced heart failure (HF). Comparative clinical data regarding the most prevalently used cf-LVADs are lacking. We aim to determine, using a head-to-head comparison, the clinical, hemodynamic and echocardiographic outcomes of patients supported with either HeartMate II (HM2), HeartWare HVAD (HW) and HeartMate 3 (HM3).

Methods: A retrospective analysis of patients who underwent cf- LVAD implantation at our institution between the years 2008-2017. Patients were followed for 18 months.

Results: Our cohort included 105 consecutive LVAD-supported patients of which 51% (n=54), 24% (25) and 25% (26) underwent implantation of HM2, HW and HM3, respectively. We found that patients supported with HM3 versus HM2 had significantly lower rates of thrombotic events (0% vs. 37%, p<0.001), while patients supported with HM3 versus HW had lower rates of non-GI bleeding (15% vs. 46%, p=0.056) and unplanned hospitalizations [median 1 (interquartile range 0,3) vs. 3 (interquartile range 2, 11), p=0.001]. Furthermore, patients supported with HM3 had a significantly lower risk for any stroke compared with either HM2 or HW (0% vs. 26%, p=0.033 and 0% vs. 42%, p=0.005, respectively). Importantly, we found a tendency for improved all-cause survival in patients supported with HM3 as compared to patients supported with the combined group of older LVADs; HM2 and HW (96% vs. 83%, p=0.076).

Conclusions: HM3 device presents the best-currently available adverse events free profile device when compared to the other widely used cf-LVADs; HM2 and HW. We believe that when required, HM3 should be offered as the device of choice for mechanical support of advanced HF patients.