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Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure.

Publication ,  Journal Article
Uriel, N; Colombo, PC; Cleveland, JC; Long, JW; Salerno, C; Goldstein, DJ; Patel, CB; Ewald, GA; Tatooles, AJ; Silvestry, SC; John, R; Sood, P ...
Published in: Circulation
May 23, 2017

BACKGROUND: The HeartMate 3 (HM3) Left Ventricular Assist System (LVAS) (Abbott) is a centrifugal, fully magnetically levitated, continuous-flow blood pump engineered to enhance hemocompatibility and reduce shear stress on blood components. The MOMENTUM 3 trial (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) compares the HM3 LVAS with the HeartMate II (HMII) LVAS (Abbott) in advanced heart failure refractory to medical management, irrespective of therapeutic intention (bridge to transplant versus destination therapy). This investigation reported its primary outcome in the short-term cohort (n=294; 6-month follow-up), demonstrating superiority of the HM3 for the trial primary end point (survival free of a disabling stroke or reoperation to replace the pump for malfunction), driven by a reduced need for reoperations. The aim of this analysis was to evaluate the aggregate of hemocompatibility-related clinical adverse events (HRAEs) between the 2 LVAS. METHODS: We conducted a secondary end point evaluation of HRAE (survival free of any nonsurgical bleeding, thromboembolic event, pump thrombosis, or neurological event) in the short-term cohort (as-treated cohort n=289) at 6 months. The net burden of HRAE was also assessed by using a previously described hemocompatibility score, which uses 4 escalating tiers of hierarchal severity to derive a total score for events encountered during the entire follow-up experience for each patient. RESULTS: In 289 patients in the as-treated group (151 the HM3 and 138 the HMII), survival free of any HRAE was achieved in 69% of the HM3 group and in 55% of the HMII group (hazard ratio, 0.62; confidence interval, 0.42-0.91; P=0.012). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 36 points, P<0.001) or medically managed pump thrombosis (0 versus 5 points, P=0.02), and fewer nondisabling strokes (6 versus 24 points, P=0.026) than the control HMII LVAS. The net hemocompatibility score in the HM3 in comparison with the HMII patients was 101 (0.67±1.50 points/patient) versus 137 (0.99±1.79 points/patient) (odds ratio, 0.64; confidence interval, 0.39-1.03; P=0.065). CONCLUSIONS: In this secondary analysis of the MOMENTUM 3 trial, the HM3 LVAS demonstrated greater freedom from HRAEs in comparison with the HMII LVAS at 6 months. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT02224755.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

May 23, 2017

Volume

135

Issue

21

Start / End Page

2003 / 2012

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Thrombosis
  • Stroke
  • Stress, Mechanical
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Odds Ratio
 

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Uriel, N., Colombo, P. C., Cleveland, J. C., Long, J. W., Salerno, C., Goldstein, D. J., … Mehra, M. R. (2017). Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure. Circulation, 135(21), 2003–2012. https://doi.org/10.1161/CIRCULATIONAHA.117.028303
Uriel, Nir, Paolo C. Colombo, Joseph C. Cleveland, James W. Long, Christopher Salerno, Daniel J. Goldstein, Chetan B. Patel, et al. “Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure.Circulation 135, no. 21 (May 23, 2017): 2003–12. https://doi.org/10.1161/CIRCULATIONAHA.117.028303.
Uriel N, Colombo PC, Cleveland JC, Long JW, Salerno C, Goldstein DJ, et al. Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure. Circulation. 2017 May 23;135(21):2003–12.
Uriel, Nir, et al. “Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure.Circulation, vol. 135, no. 21, May 2017, pp. 2003–12. Pubmed, doi:10.1161/CIRCULATIONAHA.117.028303.
Uriel N, Colombo PC, Cleveland JC, Long JW, Salerno C, Goldstein DJ, Patel CB, Ewald GA, Tatooles AJ, Silvestry SC, John R, Caldeira C, Jeevanandam V, Boyle AJ, Sundareswaran KS, Sood P, Mehra MR. Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure. Circulation. 2017 May 23;135(21):2003–2012.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

May 23, 2017

Volume

135

Issue

21

Start / End Page

2003 / 2012

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Treatment Outcome
  • Time Factors
  • Thrombosis
  • Stroke
  • Stress, Mechanical
  • Risk Factors
  • Prospective Studies
  • Proportional Hazards Models
  • Odds Ratio