@article{b1092c51e5b945c5acfd167d68db1286,
title = "Center Variability in Patient Outcomes Following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial",
abstract = "Background: As left ventricular assist device (LVAD) survival rates continue to improve, evaluating site-specific variability in outcomes can facilitate identifying targets for quality-improvement initiative opportunities in the field. Methods: Deidentified center-specific outcomes were analyzed for HeartMate 3 (HM3) patients enrolled in the MOMENTUM 3 pivotal and continued access protocol trials. Centers < 25th percentile for HM3 volumes were excluded. Variability in risk-adjusted center mortality was assessed at 90 days and 2 years (conditional upon 90-day survival). Adverse event (AE) rates were compared across centers. Results: In the 48 included centers (1958 patients), study-implant volumes ranged between 17 and 106 HM3s. Despite similar trial-inclusion criteria, patient demographics varied across sites, including age quartile ((Q)1–Q3:57–62 years), sex (73%–85% male), destination therapy intent (60%–84%), and INTERMACS profile 1–2 (16%–48%). Center mortality was highly variable, nadiring at ≤ 3.6% (≤ 25th percentile) and peaking at ≥ 10.4% (≥ 75th percentile) at 90 days and ≤ 10.2% and ≥ 18.7%, respectively, at 2 years. Centers with low mortality rates tended to have lower 2-year AE rates, but no center was a top performer for all AEs studied. Conclusions: Mortality and AEs were highly variable across MOMENTUM 3 centers. Studies are needed to improve our understanding of the drivers of outcome variability and to ascertain best practices associated with high-performing centers across the continuum of intraoperative to chronic stages of LVAD support.",
keywords = "HeartMate 3, LVAD, outcomes, site variability",
author = "Kanwar, {MANREET K.} and PAGANI, {FRANCIS D.} and MEHRA, {MANDEEP R.} and ESTEP, {JERRY D.} and PINNEY, {SEAN P.} and SILVESTRY, {SCOTT C.} and URIEL, {N. I.R.} and GOLDSTEIN, {DANIEL J.} and JAMES LONG and CLEVELAND, {JOSEPH C.} and KORMOS, {ROBERT L.} and AIJIA WANG and JOYCE CHUANG and COWGER, {JENNIFER A.}",
note = "Funding Information: The MOMENTUM 3 studies are sponsored by Abbott. MK is on the medical advisory board for Abiomed, Bayer and CareDx; FDP is a scientific advisor without compensation for FineHeart, is a member of the data safety monitoring board for Carmat and the National Heart, Lung, and Blood Institute PumpKIN clinical trial, and is Chair of The Society of Thoracic Surgeons Intermacs Task Force; JDE reports consulting fees from Abbott and Medtronic paid to his institution; SPP reports consultant fees from Abbott, CareDx, Medtronic, Procyrion, and Transmedics; SCS reports consultant fees from Abbott, Medtronic, Abiomed, and Syncardia; NU is a medical advisory board member for Livemetric and Levitcus; DG is a medical advisory board member for Abbott and receives consultant fees from Abbott and Abiomed; MRM reports payment to his institution from Abbott for consulting, consulting fees from Mesoblast, Janssen, Portola, Bayer, Triple Gene, Natera, Paragonix, and Baim Institute for clinical research, is an advisory board member for NuPulseCV, Leviticus and FineHeart; JCC reports fees from Abbott and Medtronic; RLK, AJW, and JC are employees of Abbott; JAC is a consultant and speaker for Abbott, on the steering committee for Procyrion, Endotronix, Bioventrix, and Medtronic and receives payment for fellows{\textquoteright} education supported by Zoll. Publisher Copyright: {\textcopyright} 2022 The Author(s)",
year = "2022",
month = jul,
doi = "10.1016/j.cardfail.2022.04.006",
language = "English (US)",
volume = "28",
pages = "1158--1168",
journal = "Journal of Cardiac Failure",
issn = "1071-9164",
publisher = "Churchill Livingstone",
number = "7",
}