Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure

• Published in: Circulation (New York, N.Y.) N.Y.), 2017-05, Vol.135 (21), p.2003-2012
• Main Authors: Uriel, Nir, Colombo, Paolo C, Cleveland, Joseph C, Long, James W, Salerno, Christopher, Goldstein, Daniel J, Patel, Chetan B, Ewald, Gregory A, Tatooles, Antone J, Silvestry, Scott C, John, Ranjit, Caldeira, Christiano, Jeevanandam, Valluvan, Boyle, Andrew J, Sundareswaran, Kartik S, Sood, Poornima, Mehra, Mandeep R
• Format: Article
• Language: English
• Subjects: Aged; Device Removal; Disease-Free Survival; Equipment Design; Equipment Failure; Female; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - therapy; Heart-Assist Devices - adverse effects; Hemolysis; Humans; Kaplan-Meier Estimate; Magnets; Male; Materials Testing; Middle Aged; Odds Ratio; Proportional Hazards Models; Prospective Studies; Risk Factors; Stress, Mechanical; Stroke - etiology; Thrombosis - etiology; Time Factors; Treatment Outcome; Ventricular Function, Left
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.117.028303

BACKGROUND:The HeartMate 3 (HM3) Left Ventricular Assist System (LVAS) (Abbott) is a centrifugal, fully magnetically levitated, continuous-flow blood pump engineered to enhance hemocompatibility and reduce shear stress on blood components. The MOMENTUM 3 trial (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) compares the HM3 LVAS with the HeartMate II (HMII) LVAS (Abbott) in advanced heart failure refractory to medical management, irrespective of therapeutic intention (bridge to transplant versus destination therapy). This investigation reported its primary outcome in the short-term cohort (n=294; 6-month follow-up), demonstrating superiority of the HM3 for the trial primary end point (survival free of a disabling stroke or reoperation to replace the pump for malfunction), driven by a reduced need for reoperations. The aim of this analysis was to evaluate the aggregate of hemocompatibilityrelated clinical adverse events (HRAEs) between the 2 LVAS. METHODS:We conducted a secondary end point evaluation of HRAE (survival free of any nonsurgical bleeding, thromboembolic event, pump thrombosis, or neurological event) in the short-term cohort (as-treated cohort n=289) at 6 months. The net burden of HRAE was also assessed by using a previously described hemocompatibility score, which uses 4 escalating tiers of hierarchal severity to derive a total score for events encountered during the entire follow-up experience for each patient. RESULTS:In 289 patients in the as-treated group (151 the HM3 and 138 the HMII), survival free of any HRAE was achieved in 69% of the HM3 group and in 55% of the HMII group (hazard ratio, 0.62; confidence interval, 0.42–0.91; P=0.012). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 36 points, P