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.
CITA DEL ARTÍCULO Eur J Cardiothorac Surg. 2022 Jun 15;62(1):ezac032. doi: 10.1093/ejcts/ezac032.