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Publications

Journal Article Ahead of print

PubMed: 42842428 DOI: 10.1093/ejcts/ezag234

Long-term outcomes of contemporary durable left ventricular assist device support in younger patients: a European registry for patients with mechanical circulatory support (EUROMACS) analysis.

Eur J Cardiothorac Surg

Authors: Guglielmo Gallone, Kevin M Veen, Alexander M Bernhardt, Kadir Caliskan, Emil Najjar, Ivan Netuka, Anna Mara Scandroglio, Antonio Spitaleri, Diego Sangiorgi, Peter Ivak, Arnt Fiane, Feras Khaliel, Mustafa Özbaran, Yuri Pya, Daniel Zimpfer, Gloria Färber, Jan Gummert, Bart Meyns, Paola Quattroni, Felix Schoenrath, Gaetano Maria De Ferrari, Mauro Rinaldi, Evgenij Potapov, Antonio Loforte

Affiliations

  • Cardiovascular and Thoracic Department, "Città della Salute e della Scienza" Hospital, Turin, Italy.
  • Department of Medical Sciences, University of Turin, Turin, Italy.
  • Thorax Center, Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
  • University Heart and Vascular Center Hamburg, Department of Cardiovascular Surgery, Hamburg.
  • Thorax Center, Department of Cardiology, Cardiovascular Institute, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
  • Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
  • Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic.
  • Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Ital.
  • Department of Surgical Sciences, University of Turin, Turin, Italy.
  • PhD programme in Bioengineering and Medical-Surgical Sciences, University of Turin, Politecnico di Torino, Turin, Italy.
  • Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Ravenna, Italy.
  • Department of cardiothoracic surgery, Oslo University Hospital and Faculty of Medicine, Oslo, Norway.
  • Adult Cardiac Surgery Section, Department of Surgery, Heart Center, King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia.
  • Ege University Hospital, Izmir, Turkey.
  • National Research Cardiac Surgery Center, Astana, Kazakhstan.
  • Vienna Medical University, Vienna, Austria.
  • Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany.
  • Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany.
  • Katholieke Universiteit Leuven, Leuven, Belgium.
  • EUROMACS, EACTS House, Windsor, United Kingdom.
  • Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany. DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.

Abstract

OBJECTIVES

Superior survival outcomes have been reported for younger patients receiving durable left ventricular assist devices (LVADs) in INTERMACS. We explored whether these findings extend to contemporary European practice leveraging on EUROMACS (European Registry for Patients with Mechanical Circulatory Support).

METHODS

Adult patients undergoing implantation of current-generation magnetically levitated LVADs in EUROMACS were stratified according to age groups. The primary outcome was 5-year on-device survival, censoring at heart transplantation (HT) or LVAD explantation. Secondary outcomes included LVAD explant for myocardial recovery, and survival free from major adverse events (bleeding, stroke, device-related infection, or device malfunction). Death incidence accounting for HT and support cessation as competing risks was also calculated.

RESULTS

A total of 2,850 patients undergoing HeartMate 3 implantation were included (<50 years: 23.5%; 50-59 years: 29.7%; 60-69 years: 38.0%; ≥70 years: 8.8%). Younger patients had fewer comorbidities, a higher prevalence of non-ischemic cardiomyopathy, and INTERMACS profile ≤3.Younger patients had superior on-device 5-yr survival (<50 years: 74.7%; 50-59 years: 65.5%; 60-69 years: 53.9%; ≥70 years: 48.8%; p < 0.001) and LVAD explantation for myocardial recovery (<50 years: 4.3%; 50-59 years: 1.8%; 60-69 years: 2.3%; ≥70 years: 0.4%; p = 0.031). Accounting for competing outcomes, the 5-year cumulative incidence of death was lowest among younger patients (<50 years: 20.8%; 50-59 years: 29.1%; 60-69 years: 40.8%; ≥70 years: 49.5%; p < 0.001), driven by higher HT rates. Survival free from bleeding was significantly higher in younger patients (p < 0.001). In contrast, 5-year freedom from stroke, device-related infection, and device malfunction was similar across age groups.

CONCLUSIONS

In contemporary European practice, patients <50 yrs undergoing LVAD implant had high 5-yr survival approaching that reported in cohorts of patients listed for HT. These findings support further investigation of prolonged LVAD support before HT as a potential strategy to maximize lifetime benefit in selected motivated younger candidates.

MeSH

Registries, Hemorrhage, Stroke, Incidence, Recycling, Infections, Mechanical Circulatory Support