A Decade of Durable Mechanical Circulatory Support with HeartMate 3 Across Age Groups in a Single-Center Experience

Background: Long-term real-world data after HeartMate 3 implantation remain limited, particularly regarding age-specific outcomes. We evaluated on-device survival and major adverse events across nearly a decade of experience. Methods: This retrospective single-center study included 215 patients undergoing primary HeartMate 3 implantation between January 2016 and October 2025. On-device mortality was analyzed using Aalen–Johansen cumulative incidence estimates with heart transplantation as a competing event; age-group differences were assessed using Fine–Gray regression. Transplant-censored Kaplan–Meier survival was examined secondarily, and mortality predictors were evaluated using multivariable Cox regression. Results: Median age was 53 years and median support was 603 days. At data cutoff, 149 patients remained alive on support, eight underwent transplantation, and 58 died on support. At 5 years, the cumulative incidences of on-device death and heart transplantation were 35.3% and 4.1%, respectively, with no significant age-group difference (Fine–Gray global p = 0.088). In the secondary transplant-censored Kaplan–Meier analysis, estimated survival was 87.4% at 30 days, 81.1% at 1 year, and 63.8% at 5 years. Higher preoperative creatinine was associated with mortality (HR, 1.93 per 1-mg/dL increase; 95% CI, 1.07–3.50; p = 0.029). No intrinsic pump thrombosis occurred. Conclusions: HeartMate 3 provided durable support with favorable long-term survival, although non-pump adverse events remained clinically relevant.