5-Year Outcomes of Magnetically Levitated Left Ventricular Assist Device in Advanced Heart Failure　― Japanese Cohort ―

BACKGROUND: HeartMate 3 (HM3), a magnetically levitated centrifugal-flow pump, has demonstrated superior hemocompatibility and reduced adverse events compared to HeartMate II (HMII), an axial-flow pump, in global studies. However, because long-term comparative data in Japanese patients remain scarce, in the present study we evaluated the 5-year outcomes of HM3 support by comparing them with those of HMII at 2 leading left ventricular assist device (LVAD) centers in Japan. METHODS AND RESULTS: We retrospectively analyzed 364 patients who underwent primary LVAD implantation (HM3: n=168; HMII: n=196) between 2010 and 2023. The primary endpoint included survival to transplant, recovery, or continued LVAD support free from stroke or pump replacement. At 5 years, freedom from the composite endpoint was higher in the HM3 group (75% vs. 52%; hazard ratio [HR] 0.52; P=0.001), although overall survival was comparable (90% vs. 85%; P=0.44). The HM3 group experienced significantly fewer strokes (HR 0.40; P=0.0008), bleeding events (HR 0.22; P<0.0001), and pump thrombosis (HR 0.09; P=0.003). Rates of rehospitalization, driveline infections, and late right heart failure did not differ between the groups. CONCLUSIONS: HM3 support significantly improved long-term event-free outcomes compared to HMII, despite comparable overall survival, supporting the use of HM3 as durable mechanical circulatory support devices in Japan.