Background
Objective: Assess impact of preoperative temporary mechanical circulatory support on durable LVAD (HM3) outcomes.
Methods: Adults with INTERMACS 1–3 profilesundergoing HeartMate 3 implantation (2020–2024) were analyzed from the STS INTERMACS database. Survival and stroke outcomes were compared across no tMCS, IABP, Impella 5.0/5.5 (HF-MP), and VA-ECMO cohorts using multivariable and propensity-matched analyses.
Results: Among 5,787 LVAD recipients, two-thirds were bridged with temporary MCS, with Impella 5.0/5.5 useincreasing significantly over time. Impella and IABP support were associated with improved survival compared with no tMCS, while ECMO had the worst
outcomes; importantly, Impella support improvedsurvival without increasing stroke risk after propensity matching.
Conclusion: Bridging with HF-MP before LVAD is associated with favorable survival without excess stroke.
Analysis
Reviewer’s Comments
Largest contemporary HM3 registry analysis.
HF-MP use increased substantially over study period.
HF-MP bridge associated with improved survival versus no tMCS.
Supports aggressive stabilization before durable LVAD implantation.
Findings align with growing Impella-to-LVAD experience
Limitations
Retrospective registry study.
Residual confounding despite propensity matching.
Device selection bias likely.
No granular data on management strategies.
Follow-up limited to 2 years.
