• Igor Gosev, PhamDuc ThinhDTNorthwestern University Feinberg School of Medicine, Chicago, Ill., John Y Um, Anelechi C Anyanwu, Akinobu Itoh, Kunal Kotkar, Koji Takeda, Yoshifumi Naka, Matthias Peltz, Scott C Silvestry, Gregory Couper, Marzia Leacche, Vivek Rao, Benjamin Sun, Ryan J Tedford, Nahush Mokadam, Robert McNutt, Daniel Crandall, Mandeep R Mehra, and Christopher T Salerno.
• University of Rochester, Rochester, NY. Electronic address: igor_gosev@urmc.rochester.edu.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 1; 168 (5): 14741484.e121474-1484.e12.

ObjectivesThe HeartMate 3 (Abbott) left ventricular assist device provides substantial improvement in long-term morbidity and mortality in patients with advanced heart failure. The Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study compares thoracotomy-based implantation clinical outcomes with standard median sternotomy.MethodsWe conducted a prospective, multicenter, single-arm study in patients eligible for HeartMate 3 implantation with thoracotomy-based surgical technique (bilateral thoracotomy or partial upper sternotomy with left thoracotomy). The composite primary end point was survival free of disabling stroke (modified Rankin score >3), or reoperation to remove or replace a malfunctioning device, or conversion to median sternotomy at 6-months postimplant (elective transplants were treated as a success). The primary end point (noninferiority, -15% margin) was assessed with >90% power compared with a propensity score-matched cohort (ratio 1:2) derived from the Multi-Center Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3 continued access protocol.ResultsThe study enrolled 102 patients between December 2020 and July 2022 in the thoracotomy-based arm at 23 North American centers. Follow-up concluded in December 2022. In the Implantation of the HeartMate 3 in Subjects With Heart Failure Using Surgical Techniques Other Than Full Median Sternotomy study group, noninferiority criteria was met (absolute between-group difference, -1.2%; Farrington Manning lower 1-sided 95% CI, -9.3%; P < .0025) and event-free survival was not different (85.0% vs 86.2%; hazard ratio, 1.01; 95% CI, 0.58-2.10). Length of stay with thoracotomy-based implant was longer (median, 20 vs 17 days; P = .03). No differences were observed for blood product utilization, adverse events (including right heart failure), functional status, and quality of life between cohorts.ConclusionsThoracotomy-based implantation of the HeartMate 3 left ventricular assist device is noninferior to implantation via standard full sternotomy. This study supports thoracotomy-based implantation as an additional standard for surgical implantation of the HeartMate 3 left ventricular assist device.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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