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Predictors of 5-Year Mortality in Patients Managed With a Magnetically Levitated Left Ventricular Assist Device.
Nayak, Aditi; Hall, Shelley A; Uriel, Nir; Goldstein, Daniel J; Cleveland, Joseph C; Cowger, Jennifer A; Salerno, Christopher T; Naka, Yoshifumi; Horstmanshof, Douglas; Crandall, Daniel; Wang, AiJia; Mehra, Mandeep R.
Afiliación
  • Nayak A; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.
  • Hall SA; Baylor University Medical Center, Dallas, Texas, USA.
  • Uriel N; Columbia University College of Physicians and Surgeons and New York-Presbyterian Hospital, New York, New York, USA.
  • Goldstein DJ; Montefiore Einstein Center for Heart and Vascular Care, New York, New York, USA.
  • Cleveland JC; University of Colorado School of Medicine, Aurora, Colorado, USA.
  • Cowger JA; Henry Ford Hospitals, Detroit, Michigan, USA.
  • Salerno CT; University of Chicago Medicine, Chicago, Illinois, USA.
  • Naka Y; Weill Cornell Medical College, New York, New York, USA.
  • Horstmanshof D; Integris Baptist Medical Center, Oklahoma City, Oklahoma, USA.
  • Crandall D; Abbott, Abbott Park, Illinois, USA.
  • Wang A; Abbott, Abbott Park, Illinois, USA.
  • Mehra MR; Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. Electronic address: MMEHRA@BWH.HARVARD.EDU.
J Am Coll Cardiol ; 82(9): 771-781, 2023 08 29.
Article en En | MEDLINE | ID: mdl-37612008
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. (MOMENTUM 3 IDE Clinical Study Protocol, NCT02224755; MOMENTUM 3 Pivotal Cohort Extended Follow-up PAS, NCT03982979).
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal / 6_ODS3_enfermedades_notrasmisibles Problema de salud: 11_delivery_arrangements / 6_cardiovascular_diseases / 6_other_circulatory_diseases Asunto principal: Corazón Auxiliar / Insuficiencia Cardíaca Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Contexto en salud: 11_ODS3_cobertura_universal / 6_ODS3_enfermedades_notrasmisibles Problema de salud: 11_delivery_arrangements / 6_cardiovascular_diseases / 6_other_circulatory_diseases Asunto principal: Corazón Auxiliar / Insuficiencia Cardíaca Tipo de estudio: Guideline / Prognostic_studies / Risk_factors_studies Límite: Female / Humans / Male / Middle aged Idioma: En Revista: J Am Coll Cardiol Año: 2023 Tipo del documento: Article País de afiliación: Estados Unidos
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