Propensity score-based analysis of long-term follow-up in patients supported with durable centrifugal left ventricular assist devices: The EUROMACS analysis
Potapov E.V. Nersesian G. Lewin D. Özbaran M. De By T.M.M.H. Stein J. Pya Y. Gummert J. Ramjankhan F. Zembala M.O. Damman K. Carrel T. Meyns B. Zimpfer D. Netuka I.
1 September 2021European Association for Cardio-Thoracic Surgery
European Journal of Cardio-thoracic Surgery
2021#60Issue 3579 - 587 pp.
Objectives: The HeartWare HVAD (HW) and the HeartMate3 (HM3) are presently the most commonly used continuous-flow left ventricular assist devices worldwide. We compared the outcomes of patients supported with either of these 2 devices based on data from the EUROMACS (European Registry for Patients with Mechanical Circulatory Support). Methods: A retrospective analysis of the survival and complications profile in propensity score-matched adult patients enrolled in the EUROMACS between 01 January 2016 and 01 September 2020 and supported with either an HW or HM3. Matching included demographic parameters, severity of cardiogenic shock and risk-modifying end-organ parameters that impact long-term survival. Survival on device and major postoperative adverse events were analysed. Results: Following 1:1 propensity score matching, each group consisted of 361 patients. Patients were well balanced (<0.1 standardized mean difference). The median follow-up was similar in both groups [396 (interquartile range (IQR) 112-771) days for HW and 376 (IQR 100-816) days for HM3]. The 2-year survival was similar in both groups [HW: 61% 95% confidence interval (CI) (56-67%) vs HM3: 68% 95% CI (63-73%) (stratified hazard ratio for mortality: 1.13 95% CI (0.83-1.54), P = 0.435].The cumulative incidence for combined major adverse events and unexpected readmissions was similar in both groups [subdistribution hazard ratio (SHR) 1.0 (0.84-1.21), P = 0.96]. Patients in the HW group demonstrated a higher risk of device malfunction [SHR 2.44 (1.45-3.71), P < 0.001], neurological dysfunction [SHR 1.29 (1.02-1.61), P = 0.032] and intracranial bleeding [SHR 1.76 (1.13-2.70), P = 0.012]. Conclusions: Mid-term survival in both groups was similar in a propensity-matched analysis. The risk of device malfunction, neurological dysfunction and intracranial bleeding was significantly higher in HW patients.
EUROMACS , HeartMate3 , HeartWare , Left ventricular assist device
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Department of Cardiothoracic and Vascular Surgery, German Heart Centre Berlin, Berlin, Germany
DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
Department of Cardiovascular Surgery, Ege University, Izmir, Turkey
EUROMACS Registry, EACTS, Windsor, United Kingdom
National Research Cardiac Surgery Center, Astana, Kazakhstan
Department of Thoracic, Cardiac and Vascular Surgery (Heart and Diabetes Centre), North Rhine Westphalia, Bad Oeynhausen, Germany
Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland
Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
Department of Cardiovascular Surgery, Insel-Gruppe, University of Bern, Bern, Switzerland
Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
Department of Cardiothoracic and Vascular Surgery
DZHK (German Centre for Cardiovascular Research)
Department of Cardiovascular Surgery
EUROMACS Registry
National Research Cardiac Surgery Center
Department of Thoracic
Department of Cardiothoracic Surgery
Department of Cardiac
Department of Cardiology
Department of Cardiovascular Surgery
Department of Cardiac Surgery
Department of Cardiothoracic Surgery
Department of Cardiovascular Surgery
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