The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery: third report
Theo M M H de By 1 , Felix Schoenrath 2 3 , Kevin M Veen 4 , Paul Mohacsi 5 , Julia Stein 2 3 , Khalid M M Alkhamees 6 , Kyriakos Anastasiadis 7 , Alexander Berhnardt 8 , Friedhelm Beyersdorf 9 10 , Kadir Caliskan 4 , David Reineke 11 , Kevin Damman 12 , Arnt Fiane 13 , Angeliki Gkouziouta 14 , Can Gollmann-Tepeköylü 15 , Gustafsson Finn 16 , Michal Hulman 17 , Attilio Iacovoni 18 , Antonio Loforte 19 , Bela Merkely 20 , Francesco Musumeci 21 , Petr Němec 8 , Ivan Netuka 22 , Mustafa Özbaran 23 , Evgenij Potapov 2 3 , Yuri Pya 24 , Gregorio Rábago 25 , Faiz Ramjankhan 26 , Hermann Reichenspurner 27 , Diyar Saeed 28 , Elena Sandoval 29 , Bernard Stockman 30 , Marc Vanderheyden 30 , Laurens Tops 31 , Thorsten Wahlers 32 , Michael Zembala 33 , Daniel Zimpfer 34 , Thierry Carrel 35 , Jan Gummert 36 , Bart Meyns 37
Objectives: In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era.
Methods: Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with <60% follow-ups completed were excluded. Outcomes were stratified into 3 eras (2011-2013, 2014-2017 and 2018-2020). Adverse event rates (AERs) were calculated and stratified into early phase (<3 months) and late phase (>3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (<3 vs >3 months).
Results: In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P < 0.001) and in-hospital deaths (18.5, 17.2 and 11.2; P < 0.001) decreased significantly between eras. Overall, mortality, transplants and the probability of weaning were 55, 25 and 2% at 5 years after the implant, respectively. Major infections were mainly noted early after the implant occurred (AER<3 months: 1.44 vs AER>3 months: 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant.
Conclusions: In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent.