Conference Coverage

MOMENTUM 3 HeartMate 3 LVAD ‘practice changing’

 

Key clinical point: Landmark trial paves way to much wider use of LVADs as destination therapy.

Major finding: The 2-year rate of survival free of disabling stroke or reoperation to replace or remove a malfunctioning LVAD was 79.5% with the novel HeartMate 3 LVAD, compared with 60.2% with the commonly used HeartMate II axial-flow device.

Study details: This was a randomized, unblinded, multicenter study of more than 1,000 patients with advanced heart failure.

Disclosures: The MOMENTUM 3 trial was funded by Abbott. The presenter reported receiving research grants from and serving as a consultant to the company.

Source: Mehra MR et al. ACC 18.

Dr. Hossein Almassi, FCCP

G. Hossein Almassi, MD, FCCP, comments: The reported 2- year follow-up results of MOMENTUM 3 trial on the new generation HeatMate-III magnetically levitated LVAD gives more hope to patients with end-stage heart failure for a better quality of life and longer survival and opens new doors for potentially becoming an alternative to cardiac transplantation for patients with a long waiting time on the transplant list.


 

REPORTING FROM ACC 18

The HeartMate 3 magnetically levitated left ventricular assist (LVAD) device provided far superior outcomes, compared with the widely used HeartMate II axial-flow pump at 2 years of follow-up in patients with advanced heart failure in the large multicenter MOMENTUM 3 trial, Mandeep R. Mehra, MD, reported at the annual meeting of the American College of Cardiology.

Dr. Mandeep R. Mehra Bruce Jancin/Frontline Medical News

Dr. Mandeep R. Mehra

HeartMate 3 recipients had a 90% lower risk of undergoing reoperation to replace or remove their device because of malfunction, and a stroke rate half that in the HeartMate II group.

“This was the lowest rate of stroke ever seen in any LVAD trial,” according to Dr. Mehra, medical director of the Brigham and Women’s Hospital Heart and Vascular Center, Boston, and professor of medicine at Harvard Medical School.

“We believe this is a practice-changing result in the field, and that the real implication of our findings is to reassure those who refer or treat patients with advanced heart failure that it is perhaps going to be ignorant not to refer patients for consideration for destination therapy,” he said at a press conference highlighting the MOMENTUM 3 results, also presented in a late-breaking clinical trials session.

The HeartMate 3 is a miniaturized centrifugal-flow device that fits entirely within the chest, whereas the HeartMate II requires creation of a pocket in the abdomen. The HeartMate 3 was designed to prevent pump thrombosis – a common limiting problem with the HeartMate II and other LVADs – by employing three innovations: use of wide blood-flow passages to reduce shear stress and minimize disruption of red blood cells as they pass through the pump; reliance on magnetic levitation technology to create a frictionless pump with no mechanical bearings, which are subject to wear and tear; and incorporation of an artificial fixed pulse that speeds up and slows every 2 seconds in order to minimize blood stasis, which promotes thrombosis, the cardiologist explained in a video interview.

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