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

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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.

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