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 ―
Abstract
BACKGROUND: 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. METHODS AND RESULTS: 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). CONCLUSIONS: 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.
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BibTeX
@article{imamura2026nationwide,
title = {{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 ―}},
author = {Teruhiko Imamura and Koichiro Kinugawa and Takashi Nishimura and Koichi Toda and Yoshikatsu Saiki and Hiroshi Niinami and Shinichi Nunoda and Goro Matsumiya and Hirokuni Arai and Masanobu Yanase and Norihide Fukushima and Takeshi Nakatani and Akira Shiose and Ikuko Shibasaki and Yasushi Sakata and Masaru Hatano and Minoru Ono and J-MACS Investigators},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-26-0575},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0575/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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 ―
AU - Teruhiko Imamura
AU - Koichiro Kinugawa
AU - Takashi Nishimura
AU - Koichi Toda
AU - Yoshikatsu Saiki
AU - Hiroshi Niinami
AU - Shinichi Nunoda
AU - Goro Matsumiya
AU - Hirokuni Arai
AU - Masanobu Yanase
AU - Norihide Fukushima
AU - Takeshi Nakatani
AU - Akira Shiose
AU - Ikuko Shibasaki
AU - Yasushi Sakata
AU - Masaru Hatano
AU - Minoru Ono
AU - J-MACS Investigators
PY - 2026
DA - 2026/10/14
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0575
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0575/_article
AB - BACKGROUND: 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. METHODS AND RESULTS: 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). CONCLUSIONS: 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.
SN - 1347-4820
SN - 1346-9843
ER -