Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

Aditi Nayak; Shelley A. Hall; Nir Uriel; Daniel J. Goldstein; Joseph C. Cleveland; Jennifer A. Cowger; Christopher T. Salerno; Yoshifumi Naka; Douglas Horstmanshof; Daniel Crandall; Ai Jia Wang; Mandeep R. Mehra

doi:10.1016/j.jacc.2023.05.066

Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

Aditi Nayak, Shelley A. Hall, Nir Uriel, Daniel J. Goldstein, Joseph C. Cleveland, Jennifer A. Cowger, Christopher T. Salerno, Yoshifumi Naka, Douglas Horstmanshof, Daniel Crandall, Ai Jia Wang, Mandeep R. Mehra

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged. Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial. Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years. Results: Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m² at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]). Conclusions: Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent.

Original language	English (US)
Pages (from-to)	771-781
Number of pages	11
Journal	Journal of the American College of Cardiology
Volume	82
Issue number	9
DOIs	https://doi.org/10.1016/j.jacc.2023.05.066
State	Published - Aug 29 2023
Externally published	Yes

Keywords

MOMENTUM 3
advanced heart failure
left ventricular assist device
long-term survival
mechanical circulatory support
predictors of prognosis

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

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10.1016/j.jacc.2023.05.066

Cite this

Nayak, A., Hall, S. A., Uriel, N., Goldstein, D. J., Cleveland, J. C., Cowger, J. A., Salerno, C. T., Naka, Y., Horstmanshof, D., Crandall, D., Wang, A. J., & Mehra, M. R. (2023). Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device. Journal of the American College of Cardiology, 82(9), 771-781. https://doi.org/10.1016/j.jacc.2023.05.066

Nayak, A, Hall, SA, Uriel, N, Goldstein, DJ, Cleveland, JC, Cowger, JA, Salerno, CT, Naka, Y, Horstmanshof, D, Crandall, D, Wang, AJ & Mehra, MR 2023, 'Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device', Journal of the American College of Cardiology, vol. 82, no. 9, pp. 771-781. https://doi.org/10.1016/j.jacc.2023.05.066

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title = "Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device",

abstract = "Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged. Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial. Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years. Results: Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m2 at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]). Conclusions: Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent.",

keywords = "MOMENTUM 3, advanced heart failure, left ventricular assist device, long-term survival, mechanical circulatory support, predictors of prognosis",

author = "Aditi Nayak and Hall, {Shelley A.} and Nir Uriel and Goldstein, {Daniel J.} and Cleveland, {Joseph C.} and Cowger, {Jennifer A.} and Salerno, {Christopher T.} and Yoshifumi Naka and Douglas Horstmanshof and Daniel Crandall and Wang, {Ai Jia} and Mehra, {Mandeep R.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2023",

month = aug,

day = "29",

doi = "10.1016/j.jacc.2023.05.066",

language = "English (US)",

volume = "82",

pages = "771--781",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

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number = "9",

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TY - JOUR

T1 - Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

AU - Nayak, Aditi

AU - Hall, Shelley A.

AU - Uriel, Nir

AU - Goldstein, Daniel J.

AU - Cleveland, Joseph C.

AU - Cowger, Jennifer A.

AU - Salerno, Christopher T.

AU - Naka, Yoshifumi

AU - Horstmanshof, Douglas

AU - Crandall, Daniel

AU - Wang, Ai Jia

AU - Mehra, Mandeep R.

PY - 2023/8/29

Y1 - 2023/8/29

N2 - Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged. Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial. Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years. Results: Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m2 at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]). Conclusions: Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent.

AB - Background: In advanced heart failure patients implanted with a fully magnetically levitated HeartMate 3 (HM3, Abbott) left ventricular assist device (LVAD), it is unknown how preimplant factors and postimplant index hospitalization events influence 5-year mortality in those able to be discharged. Objectives: The goal was to identify risk predictors of mortality through 5 years among HM3 LVAD recipients conditional on discharge from index hospitalization in the MOMENTUM 3 pivotal trial. Methods: This analysis evaluated 485 of 515 (94%) patients discharged after implantation of the HM3 LVAD. Preimplant (baseline), implant surgery, and index hospitalization characteristics were analyzed individually, and as multivariable predictors for mortality risk through 5 years. Results: Cumulative 5-year mortality in the cohort (median age: 62 years, 80% male, 65% White, 61% destination therapy due to transplant ineligibility) was 38%. Two preimplant characteristics (elevated blood urea nitrogen and prior coronary artery bypass graft or valve procedure) and 3 postimplant characteristics (hemocompatibility-related adverse events, ventricular arrhythmias, and estimated glomerular filtration rate <60 mL/min/1.73 m2 at discharge) were predictors of 5-year mortality. In 171 of 485 patients (35.3%) without any risk predictors, 5-year mortality was reduced to 22.6% (95% CI: 15.4%-32.7%). Even among those with 1 or more predictors, mortality was <50% at 5 years (45.7% [95% CI: 39.0%-52.8%]). Conclusions: Long-term survival in successfully discharged HM3 LVAD recipients is largely influenced by clinical events experienced during the index surgical hospitalization in tandem with baseline factors, with mortality of <50% at 5 years. In patients without identified predictors of risk, long-term 5-year mortality is low and rivals that achieved with heart transplantation, even though most were implanted with destination therapy intent.

KW - MOMENTUM 3

KW - advanced heart failure

KW - left ventricular assist device

KW - long-term survival

KW - mechanical circulatory support

KW - predictors of prognosis

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ER -

Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device

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