Impact of age, sex, therapeutic intent, race and severity of advanced heart failure on short-term principal outcomes in the MOMENTUM 3 trial

Goldstein, Daniel J.; Mehra, Mandeep R.; Naka, Yoshifumi; Salerno, Christopher T.; Uriel, Nir; Dean, David A.; Itoh, Akinobu; Pagani, Francis D.; Skipper, Eric; Bhat, Geetha; Raval, Nirav; Bruckner, Brian A.; Estep, Jerry D.; Cogswell, Rebecca; Milano, Carmelo A.; Fendelander, Lahn; O’Connell, John B.; Cleveland, Joseph C.

doi:10.1016/j.healun.2017.11.001

Cited by 37 publications

(18 citation statements)

References 22 publications

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“…An examination of survival by sex in the ADVANCE BTT+CAP trial showed comparable stroke rates between men and women (11). Similarly, sex had no impact in the six-month endpoint outcomes (including disabling strokes) of the MOMENTUM3 trial (47). Therefore, these results should be interpreted considering the influence of different anticoagulation strategies, implanted devices and patients' compliance over time.…”

Section: Discussionmentioning

confidence: 96%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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Background: Worse outcomes in women compared to men undergoing left ventricular assist device (LVAD) implantation remain an underestimated problem in heart failure (HF) patients. With device miniaturization, less-invasive LVAD implantation techniques have gained relevance, but their impact on outcomes in women is unknown. This study investigates sex-related differences in patients undergoing LVAD implantation through less-invasive procedures.Methods: This retrospective single-center cohort study included patients who underwent isolated LVAD implantation between 2011 and 2018 through less-invasive techniques. Propensity score matching (PSM) was utilized to balance preoperative heterogeneity. Primary endpoint was two-year survival, and secondary endpoints included long-term survival, surgical outcomes and postoperative adverse events. Results: Baseline analysis of 191 patients (females 18.3%) showed differences in terms of age [female (median, 52; IQR, 47-61); male (median, 58.5; IQR, 49-66); P=0.005], underlying diagnosis (P<0.001), INTERMACS profile (P=0.009), history of previous cardiac surgery (P=0.049) and preoperative creatinine values [female (median, 110; IQR, 71-146); male (median, 126; IQR, 9-168); P=0.049]. Over a follow-up of 460.68 patient-years, Kaplan-Meyer analysis showed better survival in females (P=0.027) and a similarprobability of cardiac transplantation (P=0.288). After PSM, females showed higher needs for intraoperative fresh frozen plasma (P=0.044) and platelets (P=0.001) but comparable postoperative outcomes. No sexrelated differences were noticed regarding two-year outcomes, long-term survival and adverse events. LVADrelated infections remained the most common complication with males experiencing more pump infections than women (P=0.050).Conclusions: Patients receiving less-invasive LVAD implantation do not show significant sex-related differences in short and long-term outcomes and survival. Prospective studies are needed to evaluate the role of less-invasive techniques in reducing sex-based disparities after LVAD implantation.

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Section: Discussionmentioning

confidence: 96%

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Mariani¹,

Li²,

Bounader³

et al. 2021

Ann Cardiothorac Surg

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“…There was no sex difference in stroke risk, but the HeartMate 3 cohort consisted of only 31 women. 54,55 Interestingly, the risk of stroke after 2 years of follow-up was much lower in the HeartMate 3 cohort than the HeartMate II cohort (HR 0.47 [95% CI 0.27-0.84], P=0.02).…”

Section: Adverse Events/complicationsmentioning

confidence: 97%

Sex Differences in Advanced Heart Failure Therapies

Hsich

2019

Circulation

106

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This in-depth review of sex differences in advanced heart failure therapy summarizes the existing literature on implantable cardioverter defibrillators, biventricular pacemakers, mechanical circulatory support and transplantation with a focus on utilization, efficacy/clinical effectiveness, adverse events and controversies. One will learn about the controversies regarding efficacy/clinical effectiveness of implantable cardioverter defibrillators and understand why these devices should be implanted in women even if there are sex differences in appropriate shocks. One will also learn about the sex differences with biventricular pacemakers with respect to ventricular remodeling and reduction in heart failure hospitalizations/mortality as well as possible mechanisms. One will also learn about sex differences in heart transplantation and waitlist survival. Despite similar survival for women and men with left ventricular assist devices there are sex differences in adverse events. These devices do successfully bridge women and men to transplant yet women are less likely than men to have a left ventricular assist at time of listing and time of transplantation. Finally one will learn about the concerns regarding poor outcome for men who receive female donor hearts and discover this may not be due to sex but rather size. More research is needed to better understand sex differences and further improve advanced heart failure therapy for both women and men.

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“…Low pulsatility has been proposed as a major culprit in contributing to these adverse events (Mancini & Colombo, ; Goldstein et al . ). In this CrossTalk proposal, we present the current arguments in favour of maintaining an appropriate amount of arterial pulsatility, in particular in the cerebral circulation, to lower risk in these patients.…”

Section: Schematic Of the Device Location And Components And Typical mentioning

confidence: 97%

CrossTalk proposal: Blood flow pulsatility in left ventricular assist device patients is essential to maintain normal brain physiology

Stöhr

McDonnell

Colombo

et al. 2018

The Journal of Physiology

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Impact of age, sex, therapeutic intent, race and severity of advanced heart failure on short-term principal outcomes in the MOMENTUM 3 trial

Cited by 37 publications

References 22 publications

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Sex differences in outcomes following less-invasive left ventricular assist device implantation

Sex Differences in Advanced Heart Failure Therapies

CrossTalk proposal: Blood flow pulsatility in left ventricular assist device patients is essential to maintain normal brain physiology

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