Body surface area (BSA) was identified as the sole independent preoperative predictor of postoperative replacement to a Low Flow Limit 2.0 L/min controller following HeartMate 3 implantation, with a BSA cutoff of 1.43 m2 yielding an AUC of 0.74.
Key Findings
Results
The 2.0-LFL group had significantly lower anthropometric indices compared to the Standard group.
Parameters that differed significantly included height, weight, body mass index, and body surface area (BSA).
49 patients required postoperative replacement with a controller configured with an LFL of 2.0 L/min (2.0-LFL group).
78 patients maintained the standard LFL of 2.5 L/min controller throughout follow-up (Standard group).
The 2.0-LFL group also had a shorter duration of heart failure compared with the Standard group.
Results
Multivariate analysis identified BSA as the sole independent preoperative predictor of postoperative controller replacement to an LFL 2.0 L/min configuration.
Odds ratio for BSA: 0.03 (95% confidence interval: 0.00–0.60; p = 0.022).
Multiple clinical, echocardiographic, and hemodynamic variables were evaluated in both univariate and multivariate logistic regression analyses.
No other variable reached independent significance in multivariate analysis.
Results
ROC curve analysis demonstrated that a preoperative BSA cutoff of 1.43 m2 discriminated patients requiring LFL 2.0 L/min controller replacement with moderate accuracy.
Area under the curve (AUC) = 0.74.
Specificity at this threshold: 89.7%.
Sensitivity at this threshold: 38.8%.
The high specificity suggests the threshold is more useful for ruling in the need for a 2.0 L/min controller than ruling it out.
Methods
This was a single-center, retrospective, observational study of 127 patients who underwent primary HeartMate 3 LVAD implantation.
Study period: June 2019 to March 2025.
Patients were divided into Standard group (n = 78) and 2.0-LFL group (n = 49).
Preoperative clinical, laboratory, echocardiographic, and hemodynamic parameters were compared.
Analyses included univariate and multivariate logistic regression as well as ROC curve analysis.
Conclusions
Pre-emptive selection of a 2.0 L/min LFL controller based on a BSA threshold of 1.43 m2 was proposed as a practical strategy to reduce postoperative controller replacements.
The authors suggest this approach may reduce unnecessary postoperative controller replacements.
The goal is to improve patient safety and quality of life in LVAD patients.
The study framed proactive controller selection as a means to avoid the burden of postoperative hardware changes.
What This Means
This research examined why some patients who receive a HeartMate 3 heart pump (left ventricular assist device, or LVAD) need to have their device controller swapped out after surgery for one set to a lower minimum flow rate (2.0 L/min instead of the standard 2.5 L/min). Researchers followed 127 patients at a single center and found that patients who ended up needing this controller change tended to have smaller body sizes — shorter height, lower weight, lower body mass index, and smaller body surface area (BSA). When they used statistical modeling to find which factor best predicted the need for a controller switch, BSA was the only independent predictor, with a specific cutoff value of 1.43 m2 identified as the threshold below which patients were much more likely to need the change.
The practical implication of this finding is that surgeons may be able to identify before the operation which patients are likely to need the lower-flow controller, and simply start with that configuration rather than switching devices later. A BSA of 1.43 m2 or below was associated with nearly 90% specificity, meaning that patients above this threshold were very unlikely to need the swap, though the sensitivity was lower (about 39%), meaning some smaller patients who need the change might still be missed by this cutoff alone.
This research suggests that body size — specifically BSA — is a key factor in matching LVAD controller settings to individual patients. Proactively choosing the appropriate controller before implantation could spare patients the inconvenience and potential risks associated with returning for a device change after surgery, potentially improving both safety and quality of life for LVAD recipients, particularly smaller-bodied patients.
Nishioka H, Sato T, Komiyama M, Iwanaga K, Tonai K, Kitahata N, et al.. (2026). Preoperative predictors of low flow limit controller configuration following HeartMate 3 implantation.. Journal of artificial organs : the official journal of the Japanese Society for Artificial Organs. https://doi.org/10.1007/s10047-026-01590-7