Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry: A comparison of centrifugal and axial continuous-flow left ventricular assist devices

Abstract

BACKGROUND:The IMACS Registry compiles and analyzes worldwide data from patients undergoing implantation of durable left ventricular assist devices. METHODS: Data encompassing 16,286 LVAD recipients from 4 collectives and 24 individual hospitals was collected and analyzed. In this 3rd annual report we compare and contrast outcomes, adverse events and risks factors between axial flow and centrifugal flow device recipients. RESULTS: Significant differences were found in the baseline characteristics of axial vs centrifugal flow LVAD recipients. Survival was similar between pump types. INTERMACS profile 1-3 constitute 85% of implants. A survival gap persists in destination therapy compared to bridge patients. RVAD need and delay impact survival dramatically. Centrifugal flow outperforms axial flow recipients in regards to GI bleeding and freedom from hemocompatibility related adverse events. No significant difference in the actuarial freedom from all strokes or either stroke subtype (hemorrhagic or ischemic) was seen among the two types of pumps. New end points to guide decision making are proposed. CONCLUSIONS: We demonstrate a transition from axial to centrifugal flow with four-year survival that approximates 60%. A high frequency of adverse events remains an impediment to the wider adoption of these technologies. In the future, composite study endpoints examining life quality and adverse events beyond survival may help in shared decision making prior to MCS implant, and may provide the requisite data to support extension of MCS therapy into the lesser ill heart failure population.

Heart transplantation in patients with ventricular assist devices: Impacts of the implantation technique and support duration

“…As mentioned previously, the literature is currently unclear about the long‐term effects of preoperative VAD support in HTx patients . In general, the VAD support time before HTx has been shorter in American patients than in European cohorts in publications to date, and the support duration might have been a relevant factor for these effects . Different studies reported adverse effects of prolonged VAD support time before HTx .…”

“…As this disease progresses, pharmacological therapies may fail, and current guidelines recommend orthotopic heart transplantation (HTx) as the gold standard of care . As donor organs are quite rare, circulatory assistance with implanted ventricular assist devices (VADs) is often needed as a bridge to transplant therapy . Although assist devices have substantially improved in recent years, there are still various complications, such as bleeding and severe infections, which limit the median survival time of patients with VADs to approximately 2 to 5 years, depending on individual risk profiles and device configurations .…”

The second official report from Japanese registry for mechanical assisted circulatory support (J-MACS): first results of bridge to bridge strategy

“…Analyzed J-MACS data have been uploaded on the biannual basis on the home page of the Japanese Association for Thoracic Surgery (https ://www.jpats .org/) since Oct 2018. Similar to INTERMACS [2] and IMACS [3], we have decided to publish annual report of J-MACS, and this is the second official report of J-MACS, which includes data as of Oct 30, 2018. The cut-off date for data collection of this report was Dec 31, 2018.…”

Stroke risk following implantation of current generation centrifugal flow left ventricular assist devices

“…Stroke remains a devastating complication of left ventricular assist device (LVAD) therapy and a leading cause of death during LVAD support . LVAD patients who experience a stroke have decreased life expectancy and diminished quality of life; those who are transplant candidates see a significant reduction in their chances of receiving a heart transplant …”