title: 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.
abstract: 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.
  
  
  BACKGROUND
  URL: http://clinicaltrials.gov. Unique identifier: NCT02224755.
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Nir
authors.initials: N
authors.lastname: Uriel
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Paolo C
authors.initials: PC
authors.lastname: Colombo
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: James W
authors.initials: JW
authors.lastname: Long
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Christopher
authors.initials: C
authors.lastname: Salerno
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Goldstein
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Chetan B
authors.initials: CB
authors.lastname: Patel
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Ewald
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Antone J
authors.initials: AJ
authors.lastname: Tatooles
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Scott C
authors.initials: SC
authors.lastname: Silvestry
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Christiano
authors.initials: C
authors.lastname: Caldeira
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Valluvan
authors.initials: V
authors.lastname: Jeevanandam
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Boyle
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Kartik S
authors.initials: KS
authors.lastname: Sundareswaran
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.).
authors.forename: Poornima
authors.initials: P
authors.lastname: Sood
authors.affiliation: From University of Chicago School of Medicine and Medical Center, IL (N.U., V.J.); Columbia University College of Physicians and Surgeons and New York Presbyterian Hospital, New York, NY (P.C.C.); University of Colorado School of Medicine, Denver (J.C.C.); Integris Baptist Medical Center, Oklahoma City, OK (J.W.L.); St. Vincent Heart Center, Indianapolis, IN (C.S.); Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY (D.J.G.); Duke Heart Center, Duke University, Durham, NC (C.B.P.); Washington University School of Medicine, St. Louis, MO (G.A.E.); Advocate Christ Medical Center, Chicago, IL (A.J.T.); Florida Hospital, Orlando (S.C.S.); University of Minnesota Medical Center, Minneapolis (R.J.); Tampa General Hospital, FL (C.C.); Thomas Jefferson University, Philadelphia, PA (A.J.B.); Abbott, Pleasanton, CA (K.S.S.); Abbott, Burlington, MA (P.S.); and Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA (M.R.M.). mmehra@bwh.harvard.edu.
authors.forename: Mandeep R
authors.initials: MR
authors.lastname: Mehra
mesh_terms: D000368:Aged; D020878:Device Removal; D018572:Disease-Free Survival; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006461:Hemolysis; D006801:Humans; D053208:Kaplan-Meier Estimate; D059346:Magnets; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013314:Stress, Mechanical; D020521:Stroke / Q000209:etiology; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: biocompatible materials; circulatory and respiratory physiological phenomena; heart failure; heart-assist devices; hemorrhage; thrombosis