- Question
- Is a fully magnetically levitated centrifugal-flow left ventricular assist device superior to a mechanical-bearing axial-flow device in patients with advanced heart failure?
- Design
- Multicenter, randomized, unblinded trial enrolling 1028 patients, with final analysis at 2 years. Assignment was made irrespective of the intended goal of use (bridge to transplantation or destination therapy).
- Population
- Patients with advanced, refractory left ventricular heart failure who were candidates for mechanical circulatory support, either as a bridge to transplantation or as destination therapy.
- Intervention
- Implantation of the magnetically levitated centrifugal-flow left ventricular assist device (HeartMate 3), in 516 patients.
- Control
- Implantation of the mechanical-bearing axial-flow left ventricular assist device (HeartMate II), in 512 patients.
- Primary outcome
- Composite of survival at 2 years free of disabling stroke or reoperation to replace or remove a malfunctioning device.
- Results
- At 2 years, 76.9% (397 patients) in the centrifugal-flow group vs. 64.8% (332) in the axial-flow group remained alive and free of disabling stroke or reoperation (relative risk 0.84; 95% CI 0.78 to 0.91; P<0.001 for superiority). Pump replacement was less common with the centrifugal-flow device (2.3% vs. 11.3%; relative risk 0.21; 95% CI 0.11 to 0.38; P<0.001).
- Safety
- Event rates per patient-year for stroke of any severity, major bleeding, and gastrointestinal hemorrhage were lower with the centrifugal-flow device than with the axial-flow device.
- Conclusion
- The magnetically levitated centrifugal-flow device was superior for survival free of disabling stroke or reoperation and required fewer pump replacements than the axial-flow device.
- Why it matters
- It established the magnetically levitated left ventricular assist device as the preferred option over earlier-generation axial-flow devices, by showing better clinical outcomes and less need for pump replacement.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026