Background: Advanced heart failure is a condition where pharmacological therapies have a limited impact on prognosis. Left ventricular assist devices (LVAD) have been shown to improve survival and quality of life in well-selected patients in this setting. LVAD technology has evolved over time, leading to more efficient devices with fewer complications.
Methods: This retrospective, single-center study analyzes outcomes of LVAD implants at ISMETT, comparing two devices: HeartWare (HVAD) and HeartMate 3 (HM3). Event analyses were conducted over the first year of follow-up. The primary endpoint was mortality, while secondary endpoints included adverse events such as stroke, driveline infections, heart failure, and pump thrombosis.
Results: Between 2010 and 2024, a total of 109 LVAD were implanted (10.75 implants/year). One-year survival was higher in HM3 patients (84.6%) compared to HVAD patients (78.6%). Cerebrovascular events were significantly less frequent in the HM3 group. Driveline infections were comparable between the two devices. Pump thrombosis occurred in 15.7% of HVAD patients and in none of HM3 patients. Gastrointestinal bleeding risk was significantly higher in the HVAD group, whereas the risk of right ventricular failure was similar between groups.
Conclusions: HM3 LVADs offer a superior safety profile, with reduced mortality and fewer complications compared to HVADs, reflecting technological advancements in mechanical support for advanced heart failure. This study provides new insights into LVAD patient outcomes in Italy, contributing to improved treatment strategies for this high-risk population.