Feasibility and Midterm Outcomes of Concomitant Aortic Valve Plasty in Contemporary HeartMate 3 Practice.

Abstract

De novo aortic regurgitation (AR) remains a clinically significant complication of continuous-flow left ventricular assist device support, including the HeartMate 3 (HM3). Contemporary durability and safety data for concomitant aortic valve plasty (AVP) in HM3 recipients-particularly those bridged with temporary mechanical circulatory support (tMCS)-are limited. We retrospectively analyzed 115 consecutive adults undergoing primary HM3 implantation between August 2019 and December 2024; 35 (30%) received concomitant AVP. Time-to-event outcomes were estimated using Kaplan-Meier methods with a 30 day landmark and corroborated by Aalen-Johansen competing-risk cumulative incidence functions. One early technical failure (postoperative day 1) was excluded from the primary analysis, and one additional de novo event occurred during follow-up. Freedom from greater than or equal to moderate AR in the AVP cohort was 100% at 1 year and 94.7% (95% confidence interval [CI], 68.1-99.2) at 2-3 years; AR severity distributions remained stable, with no severe AR. Operative and cardiopulmonary bypass times were longer in the AVP group, whereas early hemodynamics and in-hospital and midterm adverse-event rates were comparable. These findings support selective concomitant AVP as a feasible valve-sparing strategy in contemporary HM3 practice, including tMCS-exposed recipients. Prospective multicenter studies are warranted to refine patient selection and to characterize long-term durability.