Expanding use of the HeartMate 3 ventricular assist device in pediatric and adult patients within the Advanced Cardiac Therapies Improving Outcomes Network (ACTION)

We report current outcomes in patients supported with the HeartMate 3 ventricular assist device in a multicenter learning network.The Advanced Cardiac Therapies Improving Outcomes Network database was queried for HeartMate 3 implants between 12/2017 - 5/2022. Clinical characteristics, post-implant course, and adverse events were collected. Patients were stratified according to body surface area (<1.4 m2, 1.4-1.8 m2, and >1.8 m2) at device implantation.During the study period, 170 patients were implanted with the HeartMate 3 at participating network centers, with median age 15.3 years; 27.1% were female. Median body surface area was 1.68 m2; the smallest patient was 0.73 m2 (17.7 kg). Most (71.8%) had a diagnosis of dilated cardiomyopathy. With a median support time of 102.5 days, 61.2% underwent transplantation, 22.9% remained supported on device, 7.6% died, and 2.4% underwent device explantation for recovery; the remainder had transferred to another institution or transitioned to a different device type. The most common adverse events included major bleeding (20.8%) and driveline infection (12.9%); ischemic and hemorrhagic stroke were encountered in 6.5% and 1.2% of patients, respectively. Patients with body surface area <1.4 m2 had a higher incidence of infection, renal dysfunction, and ischemic stroke.In this updated cohort of predominantly pediatric patients supported with the HeartMate 3 ventricular assist device, outcomes are excellent with <8% mortality on device. Device-related adverse events including stroke, infection, and renal dysfunction were more commonly seen in smaller patients, highlighting opportunities for improvements in care.