Center Variability in Patient Outcomes Following HeartMate 3 Implantation: An Analysis of the MOMENTUM 3 Trial

MANREET K. Kanwar, FRANCIS D. PAGANI, MANDEEP R. MEHRA, JERRY D. ESTEP, SEAN P. PINNEY, SCOTT C. SILVESTRY, N. I.R. URIEL, DANIEL J. GOLDSTEIN, JAMES LONG, JOSEPH C. CLEVELAND, ROBERT L. KORMOS, AIJIA WANG, JOYCE CHUANG, JENNIFER A. COWGER

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1158-1168
Number of pages11
JournalJournal of Cardiac Failure
Volume28
Issue number7
DOIs
StatePublished - Jul 2022

Keywords

  • HeartMate 3
  • LVAD
  • outcomes
  • site variability

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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