Abstract
INTRODUCTION: Left ventricular assist device (LVAD) therapy is an established treatment modality for patients with advanced heart failure with reduced ejection fraction (HFrEF). This study aimed to evaluate the long-term outcomes of patients implanted with a Heartmate 3 LVAD. METHODS: We included 176 patients who were implanted with a HeartMate 3 LVAD at the University Medical Center Groningen (UMCG) between 2016 and 2025. The primary outcome of interest was on device survival. Secondary outcomes were major adverse events (including device dysfunction, major bleeding, device-related infections, ventricular tachycardia, cerebrovascular events and heart failure hospitalizations) stratified according to LVAD treatment strategy. RESULTS: Mean age at implantation was 56 ± 11 years, and 26% were female. The initial device strategy was bridge to transplant (BTT) in 24%, destination therapy (DT) in 34%, and bridge to decision (BTD) in 42%. Overall survival was 87%, 82% and 61% at 1, 2 and 5 years respectively. Kaplan-Meier analysis suggested longer on-device survival in BTT compared with DT patients, although interpretation is limited by differential censoring due to transplantation. Device-related infections and heart failure hospitalizations were the most common major adverse events, occurring 0.29 and 0.18 events per patient-year at risk, respectively. Device dysfunction and cerebrovascular events were rare, with incidence rates of 0.04 and 0.02 events per patient-year at risk, respectively. No LVAD pump thrombosis events were recorded during this time period. CONCLUSION: Long-term survival on HeartMate 3 LVAD support exceeded 60% at 5 years in this single-centre cohort. While adverse events such as device related infections and heart failure hospitalizations continue to pose a substantial clinical challenge, the incidence of thrombotic complications was low, underscoring improvement in clinical outcomes with current generation centrifugal LVAD devices.