Shah Syed Raza, Issa Najim Najla, Shah Syed Arbab, Shahnawaz Waqas, Ahmed Jangda Muhammad
Department of Internal Medicine, North Florida Regional Medical Center, University of Central Florida (Gainesville), Gainesville, FL, USA.
Department of Internal Medicine, National Children Hospital, Washington DC, USA.
J Community Hosp Intern Med Perspect. 2018 Dec 11;8(6):357-359. doi: 10.1080/20009666.2018.1536240. eCollection 2018.
Advanced Heart Failure (AHF) is a complex syndrome that affects the physiology of the heart to maintain efficient blood circulation resulting in multiorgan failure and, eventually, death. Left Ventricular Assist Devices (LVADs) have become the cornerstone therapy for AHF patients, both as a bridge to transplantation and as a decisive therapy. Recently the results of the MOMENTUM 3 Trial were published. The trial compared HeartMate 3 LVAD with HeartMate II LVAD in a randomized trial in The Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3). Of 366 patients, 190 were assigned to the centrifugal-flow pump group (HeartMate 3) and 176 to the axial-flow (HeartMate II) pump group. In the intention-to-treat population, the primary end point occurred in 151 patients (79.5%) in the centrifugal-flow pump group, as compared with 106 (60.2%) in the axial-flow pump group (P < 0.001 for noninferiority). Reoperation for pump malfunction was less frequent in the centrifugal-flow pump group than in the axial-flow pump group (P < 0.001).The results of the MOMENTUM 3 Trial are a big achievement in the cardiovascular world. Any improvement in LVADs that reduces the risk of stroke, perhaps the most feared complication of these devices, would be meaningful. Besides, given the observed lower rate of pump thrombosis and reoperation for pump malfunction, it already seems likely that the HeartMate 3 will supplant the HeartMate II in clinical practice. In addition, the risks that are associated with reoperation undoubtedly counterbalanced any unintentional bias in performing that intervention.
晚期心力衰竭（AHF）是一种复杂的综合征，它会影响心脏的生理功能以维持有效的血液循环，从而导致多器官功能衰竭并最终死亡。左心室辅助装置（LVADs）已成为AHF患者的基石疗法，既作为移植的桥梁，也作为决定性疗法。最近，MOMENTUM 3试验的结果发表了。该试验在“使用HeartMate 3进行机械循环支持治疗的患者中磁悬浮技术的多中心研究（MOMENTUM 3）”的随机试验中，将HeartMate 3左心室辅助装置与HeartMate II左心室辅助装置进行了比较。在366例患者中，190例被分配到离心式泵组（HeartMate 3），176例被分配到轴流式（HeartMate II）泵组。在意向性治疗人群中，离心式泵组有151例患者（79.5%）出现主要终点事件，而轴流式泵组为106例（60.2%）（非劣效性P<0.001）。离心式泵组因泵故障进行再次手术的频率低于轴流式泵组（P<0.001）。MOMENTUM 3试验的结果是心血管领域的一项重大成就。左心室辅助装置的任何改进，只要能降低中风风险（这可能是这些装置最令人担忧的并发症），都将具有重要意义。此外，鉴于观察到的泵血栓形成率和因泵故障进行再次手术的发生率较低，HeartMate 3似乎很有可能在临床实践中取代HeartMate II。此外，与再次手术相关的风险无疑抵消了进行该干预时的任何无意偏差。
