Increased Risk of Pneumonia Among Patients With HeartMate 3 LVAD as Bridge to Heart Transplantation

Background Left ventricular assist devices (LVADs) are commonly used as a bridge to heart transplantation (HT). The HeartMate 3 (HM3) LVAD's proximity to the lung may expose patients to pulmonary complications during explantation. This study aimed to assess the risk of pneumonia following HT among HM3 patients bridged to HT. Methods We retrospectively analyzed all adults who underwent HT at NYP‐Columbia between 2016‐2022. Patients bridged with HM3 LVAD were compared to controls bridged to HT without LVAD. The primary outcome was pneumonia incidence during index hospitalization. Categorical data were compared using Fisher and Wilcoxon tests. Multivariable logistic regression identified predictors of pneumonia. Results 281 patients were included, 82 with HM3 and 199 controls. Average age at HT and race were similar between groups. HM3 patients had more males and COPD/asthma, though less pulmonary hypertension. HM3 patients had a 79% increase in pneumonia incidence during index hospitalization (43% vs. 24%, p = 0.004) and an 83% increase in pneumonia incidence up to one year post‐HT (55% vs. 30%, p = 0.001). HM3 patients had longer intensive care unit stays and mechanical ventilation duration. After adjustment, HM3 remained an independent predictor of post‐HT pneumonia (OR 2.19; 95% CI 1.21‐3.99; p = 0.010). Among HM3 patients, prior coronary artery bypass graft was an additional risk factor for post‐HT pneumonia. Conclusion HM3 as bridge to HT is associated with an increased risk of post‐HT pneumonia. Given these findings, enhanced antimicrobial prophylaxis and surgical techniques warrant further investigation.