Nationwide Evolution of Durable Left Ventricular Assist Device Outcomes Following Introduction of the HeartMate 3 and Destination Therapy in Japan　- The Third Official Report From J-MACS.

Authors

Teruhiko Imamura, Koichiro Kinugawa, Takashi Nishimura, Koichi Toda, Yoshikatsu Saiki, Hiroshi Niinami, Shinichi Nunoda, Goro Matsumiya, Hirokuni Arai, Masanobu Yanase, Norihide Fukushima, Takeshi Nakatani, Akira Shiose, Ikuko Shibasaki, Yasushi Sakata, Masaru Hatano, Minoru Ono, J-MACS Investigators

Published in

Circulation journal : official journal of the Japanese Circulation Society. Oct 14, 2026. Epub Oct 14, 2026.

Abstract

The nationwide impact in Japan of contemporary improvement in the clinical management of durable left ventricular assist device (LVAD), together with the introduction of the HeartMate 3 (Abbott, Pleasanton, CA, USA), on clinical outcomes remains uncertain.
Using the Japanese Registry for Mechanically Assisted Circulatory Support (J-MACS), we analyzed all patients undergoing durable LVAD implantation in Japan between 2011 and 2025. Patients were divided into an early era (up to 2018) and the contemporary era (since 2019), reflecting introduction of the HeartMate 3 in Japan. The primary outcome was all-cause mortality during LVAD support. Among 1,859 patients, 1,587 underwent bridge-to-transplantation and 272 underwent destination therapy. Survival improved significantly in the contemporary era compared with the early era (5-year survival 84% vs. 76%, respectively; P=0.0002). Device dysfunction-free, pump thrombus-free, stroke-free, major bleeding-free, and pump exchange-free survival also improved significantly after 2019 (all P<0.0001). Right ventricular failure and ventricular arrhythmia that required appropriate defibrillation remained frequent complications. Among patients who received a durable LVAD since 2019, destination therapy recipients had lower survival than bridge-to-transplantation recipients (3-year survival 81% vs. 91%; P=0.0057).
Clinical outcomes after durable LVAD implantation improved substantially following the introduction of HeartMate 3 in Japan, particularly regarding pump-related and hemocompatibility-related complications. However, right ventricular failure and ventricular arrhythmia remain major unresolved challenges.

PMID:
42875230
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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