HeartMate 3 LVAD as Destination Therapy can change Concept of Advanced Heart Failure Management: A Systematic Review and Meta Analysis in terms of Survival benefits and limitations

Abstract

Background: Heart failure (HF) is an important public health problem worldwide, with the burden of HF over 60 million people. Although the medical therapy has progressed greatly, HF is still a major source of morbidity and mortality and it needs new innovative technologies like mechanical circulatory support. Left ventricular assist devices (LVADs) have progressed from bridge-to-transplant to destination therapy (DT), providing long-term cardiovascular support to individuals who are not candidates for transplantation, with studies demonstrating superior survival and quality of life, based on the use and effectiveness of LVADs. Based on its magnetically levitated rotor and artificial pulse, the HeartMate 3 LVAD is the latest generation of continuous-flow devices used to augment life-saving and minimization of complications.

 Objectives: systematically review and summarize the survival benefits, complication rate and quality of life outcomes of the HeartMate 3 LVAD as a destination treatment in end-stage patient with heart failure.

Methods: A systematic search of PubMed, Embase, Cochrane Library and Scopus (2017–2025) resulted in the identification of RCTs, cohort studies and registry analyses that assessed HeartMate 3 in adult patients with advanced HF (INTERMACS profiles 1–4). Outcomes were survival, adverse events, and functional measures. pooled data were obtained through random-effects meta-analysis, and the risk of bias was assessed with Cochrane RoB 2.0 and Newcastle–Ottawa Scale.

 Results: Twenty-five studies met the inclusion criteria of more than 10,000 patients, including randomized controlled trials, cohort studies, and registry analyses. A pooled 1-year survival was 82–85%, and 2 years survival was 75–78%, both of which were statistically better than HeartMate II (HR 0.72, 95% CI 0.60–0.85). Pump thrombosis was seen in < 2%, stroke in 7–9%, gastrointestinal bleeding in 20–25% and driveline infections in 15–20%. A standardized evaluation of quality of life revealed that NYHA class, 6-minute walk distance, and Kansas City Cardiomyopathy Questionnaire scores showed clinically meaningful measures.

Conclusion: The HeartMate 3 LVAD presents long-term survival and functional benefit as destination therapy, most in patients with INTERMACS profiles 2–3. We propose these results to redefine and expand the use of advanced HF in non-transplant candidates. Despite hemorrhaging and infection-related complications, its favorable safety profile and patient-centered outcomes allow for overall use in non-transplant candidates selected carefully