Heart Replacement Therapy in Young Patients

BACKGROUND: Younger patients (18-49 years of age) with advanced heart failure (HF) face unique challenges in decision-making for advanced HF therapies. Although heart transplantation (HT) offers excellent survival, it is associated with finite graft longevity. The HeartMate 3 (HM3) left ventricular assist device (LVAD) has demonstrated promising outcomes, but direct comparisons with those listed for or undergoing HT in this age group remain limited. OBJECTIVES: This study sought to compare survival and adverse event (AE) outcomes between younger patients receiving HM3 LVAD support and those listed for or undergoing HT. METHODS: The authors analyzed patients 18-49 years of age from the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3) portfolio (HM3 cohort; n = 420) and the UNOS (United Network for Organ Sharing) registry (HT listing cohort; n = 1,955) (HT recipients; n = 1,176) from 2014-2018. Propensity score matching was performed to adjust for baseline differences. Outcomes included 2-year survival from time of treatment or time of listing, freedom from death or delisting for deterioration, and 1-year incidence of major AEs (ie, stroke, renal dysfunction, infection). RESULTS: After propensity score matching, 2-year survival from treatment was similar for HM3 and HT (88.7% vs 90.2%; HR: 1.18; P = 0.53). When comparing outcomes from time of transplant listing vs LVAD implantation, HM3 was associated with higher freedom from death compared with freedom from death or delisting due to deterioration in UNOS (90.1% vs 76.7%; HR: 0.38; P < 0.0001). AE analysis showed lower 1-year rates of renal dysfunction requiring dialysis (5.0% vs 10.4%; P = 0.016) and fewer infection-related hospitalizations (24.8% vs 34.2%; P = 0.012) in HM3 recipients, but a higher incidence of debilitating stroke (3.4% vs 0.3%; P = 0.027). CONCLUSIONS: Contemporary data suggest that durable LVAD therapy may offer survival outcomes comparable to HT in adults