Nationwide Evolution of Durable Left Ventricular Assist Device Outcomes Following Introduction of the HeartMate 3 and Destination Therapy in Japan - The Third Official Report From J-MACS.
Durable LVAD outcomes in Japan improved substantially with HeartMate 3, and the residual failure modes are right-sided.
The third J-MACS report, 1,859 patients from 2011 to 2025 , shows 5-year survival of 84% in the post-2019 era versus 76% before, with significant gains in freedom from pump thrombosis, stroke, major bleeding, and pump exchange.
BACKGROUND: The nationwide impact in Japan of contemporary improvement in the clinical management of durable left ventricular assist device (LVAD), together with the introduction of the HeartMate 3 (Abbott, Pleasanton, CA, USA), on clinical outcomes remains uncertain. METHODS AND RESULTS: Using the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS), we analyzed all patients undergoing durable LVAD implantation in Japan between 2011 and 2025. Patients were divided into an early era (up to 2018) and the contemporary era (since 2019), reflecting introduction of the HeartMate 3 in Japan. The primary outcome was all-cause mortality during LVAD support. Among 1,859 patients, 1,587 underwent bridge-to-transplantation and 272 underwent destination therapy. Survival improved significantly in the contemporary era compared with the early era (5-year survival 84% vs. 76%, respectively; P=0.0002). Device dysfunction-free, pump thrombus-free, stroke-free, major bleeding-free, and pump exchange-free survival also improved significantly after 2019 (all P<0.0001). Right ventricular failure and ventricular arrhythmia that required appropriate defibrillation remained frequent complications. Among patients who received a durable LVAD since 2019, destination therapy recipients had lower survival than bridge-to-transplantation recipients (3-year survival 81% vs. 91%; P=0.0057). CONCLUSIONS: Clinical outcomes after durable LVAD implantation improved substantially following the introduction of HeartMate 3 in Japan, particularly regarding pump-related and hemocompatibility-related complications. However, right ventricular failure and ventricular arrhythmia remain major unresolved challenges.
- Transplant & MCS· International medical case reports journalExtracorporeal Cardiopulmonary Resuscitation as a Bridge to Cardiac Transplantation in Refractory Cardiac Arrest Due to Fulminant Myocarditis: A Case Report.
- Transplant & MCS· Minerva surgeryCardiac xenotransplantation: from concept to clinical reality.
- Transplant & MCS· Transplantation proceedingsSequential Liver, Kidney, and Heart Transplantation in a Single Recipient: Long-Term Survival Complicated by Chronic Renal Allograft Failure, Lung Cancer, and Recurrent Infection-A Case Report.
- Clinical Trials Update· Annals of Thoracic SurgeryTopical Vancomycin for Prevention of Grade 2 or Higher Sternal Wound Infection After Cardiac Surgery: A Randomized Controlled Trial
- Coronary Surgery· CureusMore Than Skin Deep: Loculated Pericardial Effusion Causing Localized Cardiac Tamponade Due to Cutibacterium acnes Pericarditis.
- Coronary Surgery· Frontiers in medicineThe red blood cell distribution width-to-albumin ratio and 28-day mortality in patients with severe cardiogenic shock: a retrospective cohort study based on MIMIC-IV with single-center external validation.