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Left ventricular assist devices (LVAD) improve two-year survival and quality of life in patients with advanced heart failure. Following the MOMENTUM 3 study, Heartmate 3 (HM3) LVAD is the only device approved in the US and Europe. Data for event-free survival beyond two years on HM 3 is limited. The aim of this study was to assess the adverse event profile in patients who survive more than 2 years on support. We retrospectively reviewed all patients who received a HM3 LVAD at our center between 5/8/2015-10/29/2018. Patients who were alive two years following LVAD implant and were still on LVAD support were included in the study and followed for an additional two years. Patient outcomes including hospitalizations over the subsequent two years of follow-up were recorded (between year 2 and 4). Event percent per year (EPPY) was calculated for each of these outcomes. 127 patients received an LVAD during the study period with a 2 year survival rate of 85.1%. Within the first 2 years, 19 patients died, 39 patients were transplanted, and 13 transferred institutions or were lost to follow up. 56 patients remained on support and were included in this analysis and followed for an additional 2 years. The average age was 61 ± 14, 81% were male. Of those 56 patients, 50 patients were alive on support 4 years after LVAD implant (89%) (3 died and 3 patients underwent transplant). Between years 2 and 4 years from HM 3 implant, 51% were hospitalized. The most common causes of hospitalization were ADHF (0.142 EPPY), drive line infection (DLI) (.0268 EPPY) and GI bleed (0.0089 EPPY). In patients surviving 2 years on HM3 LVAD support the overall survival rate for additional 2 years is excellent. However, half of the patients will be hospitalized during long-term support, highlighting the need for more studies of medical management to prevent complications in this cohort of patients. [ABSTRACT FROM AUTHOR]