Nir Uriel, Gabriel T. Sayer, Paolo C. Colombo, M Yuzefpolskaya, Ilan Richter, Daniel J. Goldstein, Ulrich P. Jorde, Joseph C. Cleveland, Mandeep R. Mehra, Stavros G. Drakos, I Gosev, Finn Gustafsson, John D Henderson, F. Lee, Manreet K. Kanwar, Kevin J. Clerkin
BACKGROUND: Heart failure (HF) increases in prevalence with age. For patients with advanced HF, both durable left ventricular assist devices (LVADs) and heart transplantation (HT) can improve longevity and quality of life. However, comparing optimal outcomes between the 2 therapies in middle-aged and older patients who are eligible for both remains controversial. OBJECTIVES: This study aims to report survival and adverse events in middle-aged (50-64 years of age) and older (≥65 years of age) adults with advanced HF who received the HeartMate 3 (HM3) (Abbott) LVAD or were listed for or underwent HT. METHODS: The authors analyzed patients from the MOMENTUM 3 IDE (Multi-Center Study of MagLev Technology in Patients Undergoing MCS [Mechanical Circulatory Support] Therapy with HeartMate 3 IDE [Investigational Device Exemption] Protocol; and MOMENTUM 3 CAP [Continued Access Protocol]) HM3 cohort (N = 1,763) and the UNOS (United Network for Organ Sharing) registry (N = 5,336) from 2014 to 2018, by using propensity score matching to adjust for baseline differences. Outcomes included 2-year survival from treatment or listing and 1-year major adverse events (stroke, renal dysfunction, infection-related hospitalization). RESULTS: After matching, HT demonstrated higher 2-year survival when measured from treatment (middle-aged group: 90.7% vs 83.8%; HR: 1.76; P = 0.0004; older group: 87.5% vs 77.7%; HR: 1.89; P < 0.0001). However, when incorporating the waitlist period, HM3 survival was higher compared with survival free from delisting resulting from deterioration in middle-aged HT candidates (83.0% vs 75.0%; HR: 0.62; P < 0.0001). Among older adults, accounting for the waitlist resulted in numerically higher HM3 survival relative to HT candidates (76.6% vs 72.2%; HR: 0.81; P = 0.064). CONCLUSIONS: The 2-year survival was higher post-HT compared with HM3 use; however, when including pre-HT waitlist time, HM3 therapy demonstrated higher survival than survival free from delisting resulting from deterioration in HT candidates. These findings underscore the importance of considering wait time when discussing advanced HF therapies. (Multi-Center Study of MagLev Technology in Patients Undergoing MCS [Mechanical Circulatory Support] Therapy with HeartMate 3 IDE [Investigational Device Exemption] Protocol [MOMENTUM 3 IDE]; NCT02224755; and Continued Access Protocol [MOMENTUM 3 CAP]; NCT02892955).