The fourth report of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardiothoracic Surgery: focus on standardized outcome ratios

Veen K.M. Ahmed M. Stark C. Botta L. Anastasiadis K. Bernhardt A. Berchtold-Herz M. Caliskan K. Reineke D. Damman K. Fiane A. Gkouziouta A. Gollmann-Tepekoyl C. Najjar E. Hulman M. Iacovoni A. Loforte A. Merkely B. Musumeci F. Comisso M. Nemec P. Netuka I. Ozbaran M. Potapov E. Pya Y. Rabago G. Ramjankhan F. Scandroglio A.M. Pieri M. Reichenspurner H. Dashkevich A. Stockman B. Vanderheyden M. Tops L. Wahlers T. Przybyłowski P. Zimpfer D. Løgstrup B.B. Santer D. Farber G. Gummert J. Meyns B. de By T.M.M.H. Schoenrath F.
1 February 2025 European Association for Cardio-Thoracic Surgery

European Journal of Cardio-thoracic Surgery
2025 #67 Issue 2

OBJECTIVES: This 4th report aimed to provide insights into patient characteristics, outcomes and standardized outcome ratios of patients implanted with durable Mechanical Circulatory Support across participating centres in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) registry. METHODS: All registered patients receiving durable mechanical circulatory support up to August 2024 were included. The expected number of events was predicted using penalized logistic regression. Standardized outcome ratios (Observed/Expected events) were presented in plots to assess 30-day and 1-year mortality, ischaemic stroke and major bleeding outcomes. Expected events were estimated using penalized logistic regression using demographics and comorbidities as predictors. Centres with <90% follow-up completeness were excluded from standardized outcome ratio assessment. RESULTS: Analysis included 6962 implants in 6408 patients (457 patients underwent repeated implants) registered in EUROMACS from 17 countries (32 centres) (median age: 58 years, 83% males, 17% Interagency Registry for Mechanically Assisted Circulatory Support class 1). Thirty-day mortality, major bleeding and ischaemic stroke probabilities were 9.6, 12.6% and 2.1%, respectively. Standardized mortality ratios showed variability between centres, ranging from 0 (95% CI 0–0) to 1.4 (95% CI 1.2–1.7). Higher standardized bleeding outcome ratios correlated with higher standardized ischaemic stroke ratio’s (Spearman r: 0.56, P ¼ 0.008). CONCLUSIONS: Most included centres perform as expected given the demographics and comorbidities of patients. A positive correlation was found between standardized bleeding and ischaemic stroke ratios, reflecting the need of continuously monitoring of adverse events by quality improvement programs.

EUROMACS , Left ventricular assist device , Mechanical circulatory support

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Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, Netherlands
EUROMACS, EACTS House, Windsor, United Kingdom
Department of Cardiac Surgery, Helsinki University Hospital, Helsinki, Finland
IRCCS AOU di Bologna Sant’Orsola, Dept of cardiac surgery, San Orsola Hospital, Bologna, Italy
Cardiothoracic Department, Aristotle University, AHEPA University Hospital, Thessaloniki, Greece
Department of Cardiovascular Surgery, University Heart, Vascular Center Hamburg, Hamburg, Germany
Department of Cardiovascular Surgery, University Hospital Freiburg, Freiburg, Germany
Department of Cardiology, Thorax Center, Cardiovascular Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
Department of Cardiovascular Surgery, University Hospital Bern, Switzerland
Universitair Medisch Centrum Groningen, University of Groningen, Groningen, Netherlands
Department of Cardiothoracic Surgery, Rikshospitalet, Oslo, Norway
Onassis Cardiac Surgery Center, Athens, Greece
Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
Department of Cardiac Surgery, Klinika Kardiochirurgie NUSCH, Bratislava, Slovakia
Department of Transplant Surgery and Surgical Treatment of Heart Failure, Ospedale Papa Giovanni XIII, Bergamo, Italy
Department of Cardiothoracic, Transplantation and Vascular Surgery, Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza Torino, Turin, Italy
Department of Cardiology, Heart Center of the Semmelweis University, Hungary
Cardiac Surgery and Heart Transplantation Unit, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
Department of Cardiovascular Surgery and Transplantations, Center for Cardiovascular Surgery and Transplantation Surgery, Brno, Czech Republic
Department of Cardiovascular Surgery, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
Department of Cardiovascular Surgery, Ege University Hospital, Izmir, Turkey
Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charite (DHZC), Berlin, Germany
DZHK (German Centre for Cardiovascular Research), Berlin, Germany
National Research Cardiac Surgery Center, Astana, Kazakhstan
Cardiology and Cardiac Surgery Department, Clinica Universidad de Navarra, Pamplona, Spain
Department of Cardiothoracic Surgery, Utrecht University Medical Center, Utrecht, Netherlands
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milano, Italy
Department of Cardiovascular surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Department of Cardiac Surgery, Herzzentrum Leipzig, Leipzig, Germany
Department of Cardiovascular Surgery, Onze Lieve Vrouwenziekenhuis, Aalst, Belgium
Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
Department for Cardiothoracic Surgery Heart Center, Universit€atsklinikum Koln € AoR, Koln, Germany
Silesian Center for Heart Diseases, Zabrze, Poland
Department of Cardiac Surgery, Vienna Medical University, Vienna, Austria
Department of Cardiology, Arhus University Hospital, Arhus, Denmark
Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland
Department of Cardiac Surgery, Saarland University Medical Center, Homburg, Germany
Universit€ats-Herzzentrum Thuringen, Jena, Germany
Department of Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany
Department of Cardiac Surgery, Katholieke Universiteit Leuven, Leuven, Belgium

Department of Cardiothoracic Surgery
EUROMACS
Department of Cardiac Surgery
IRCCS AOU di Bologna Sant’Orsola
Cardiothoracic Department
Department of Cardiovascular Surgery
Department of Cardiovascular Surgery
Department of Cardiology
Department of Cardiovascular Surgery
Universitair Medisch Centrum Groningen
Department of Cardiothoracic Surgery
Onassis Cardiac Surgery Center
Department of Cardiac Surgery
Department of Medicine
Department of Cardiac Surgery
Department of Transplant Surgery and Surgical Treatment of Heart Failure
Department of Cardiothoracic
Department of Cardiology
Cardiac Surgery and Heart Transplantation Unit
Department of Cardiovascular Surgery and Transplantations
Department of Cardiovascular Surgery
Department of Cardiovascular Surgery
Department of Cardiothoracic and Vascular Surgery
DZHK (German Centre for Cardiovascular Research)
National Research Cardiac Surgery Center
Cardiology and Cardiac Surgery Department
Department of Cardiothoracic Surgery
Department of Anesthesia and Intensive Care
Department of Cardiovascular surgery
Department of Cardiac Surgery
Department of Cardiovascular Surgery
Department of Cardiology
Department for Cardiothoracic Surgery Heart Center
Silesian Center for Heart Diseases
Department of Cardiac Surgery
Department of Cardiology
Department of Cardiac Surgery
Department of Cardiac Surgery
Universit€ats-Herzzentrum Thuringen
Department of Thoracic and Cardiovascular Surgery
Department of Cardiac Surgery

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