The use of left-ventricular assist devices in patients with advanced-stage heart failure is often associated with complications that arise as a consequence of adverse interactions between the device and circulating blood elements. Although bioengineering advances have led to the introduction of durable continuous-flow devices, device malfunction remains a concern.
The MOMENTUM 3 randomized study assessed a fully magnetically levitated (MagLev) centrifugal-flow left-ventricular assist device in patients with advanced-stage heart failure, comparing the system with a mechanical-bearing axial-flow left-ventricular assist system to determine the benefit in terms of reduced stroke occurrence and the need to re-operate to remove/replace the device. Of the 516 patients fitted with the MagLev device, 397 (76.9%) remained alive and free of disabling stroke or re-operation to remove/replace a malfunctioning device at 2 years, compared with 332 of the 512 patients (64.8%) in the mechanical-bearing device group (relative risk [RR]: 0.84; 95% confidence interval [CI]: 0.78–0.91; p<0.001 for superiority); pump replacement was less common with the MagLev device, with 12 (2.3%) MagLev vs 57 (11.3%) mechanical-bearing patients requiring re-operation for pump replacement at 2 years (RR: 0.21; 95% CI: 0.11–0.38; p<0.001). In terms of stroke reduction, the number of events per patient-year for stroke of any severity, major bleeding, and gastrointestinal haemorrhage were lower in the MagLev group than in the mechanical-bearing group.
These findings suggest that in patients with advanced-stage heart failure, fully magnetically levitated centrifugal-flow left-ventricular assist devices are associated with less frequent need for pump replacement than mechanical-bearing axial-flow devices, and are superior in terms of stroke occurrence.
Original article: N Engl J Med 2019; 380:1618-1627
Author: Daniel Guns, Cardiology Update