Prognostic Value of the HeartMate Three Risk Score for LVAD Candidates: A Tertile-Specific Survival Estimates Using Kaplan–Meier Derived Data

All articles of this category (opens in new window) Background: Left ventricular assist device (LVAD) implantation requires careful patient selection and shared decision-making. The HeartMate 3 Risk Score (HM3-RS) was developed to predict individualized 1- and 2-year survival using routinely available preimplantation parameters, but its performance outside the MOMENTUM trial remains unclear. Methods: We systematically reviewed the literature up to July 2025 to identify studies reporting HM3-RS results. Individual patient data were reconstructed from Kaplan–Meier curves. Patients were stratified into low-, average-, and high-risk tertiles. One- and 2-year survival rates were calculated, as well as the discriminative ability of the HM3-RS. Results: A total of 1,348 patients who received HM3 from three real-world cohorts and the MOMENTUM trial were included. One-year survival was 94%, 87%, and 76% for low-, average-, and high-risk tertiles, respectively. Two-year survival was 89%, 80%, and 70%. Table 1 . Compared with low-risk patients, high-risk patients had an HR of 3.25 (95% CI: 2.31–4.56), while average-risk patients had an HR of 1.87 (95% CI: 1.31–2.67). The estimated C-index for HM3-RS was 0.68, indicating moderate discriminative ability. These results demonstrate a clear gradient of survival across HM3-RS tertiles. Table 1 Year-specific survival estimates across the HM3-RS tertiles Score Overall ( n = 1,348) Real-world data ( n = 807 ) a 1-y survival 2-y survival 1-y survival 2-y survival Low-risk tertile 94.3 ± 1.1% 88.7 ± 1.6% 93.1 ± 1.4% 87.2 ± 2.0% Average-risk tertile 86.5 ± 1.6% 80.2 ± 2.0% 86.4 ± 2.1% 78.2 ± 2.9% High-risk tertile 75.9 ± 2.2% 69.9 ± 2.5% 76.6 ± 3.0% 71.9 ± 3.3% a Excluding patients enrolled in the MOMENTUM trial. Conclusion: The HM3-RS provides meaningful prognostic stratification for LVAD patients before implantation. The difference was most prominent between the low- and high-risk tertiles. The High-risk tertile was associated with lower survival and greater mortality, supporting its use for risk-adapted clinical decision-making. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany