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

Daniel J. Goldstein, Bart Meyns, Rongbing Xie, Jennifer Cowger, Stephen Pettit, Takeshi Nakatani, Ivan Netuka, Steven Shaw, Masanobu Yanase, James K. Kirklin

Research output: Contribution to journalArticle

8 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)352-363
Number of pages12
JournalJournal of Heart and Lung Transplantation
Volume38
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Annual Reports
Heart-Assist Devices
Registries
Survival
Decision Making
Stroke
Heart Failure
Quality of Life
Hemorrhage
Technology
Equipment and Supplies
Therapeutics
Population

Keywords

  • axial flow
  • centrifugal flow
  • continuous-flow left ventricular assist devices
  • IMACS
  • International Society for Heart and Lung Transplantation
  • mechanical circulatory support

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine
  • Transplantation

Cite this

Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry : A comparison of centrifugal and axial continuous-flow left ventricular assist devices. / Goldstein, Daniel J.; Meyns, Bart; Xie, Rongbing; Cowger, Jennifer; Pettit, Stephen; Nakatani, Takeshi; Netuka, Ivan; Shaw, Steven; Yanase, Masanobu; Kirklin, James K.

In: Journal of Heart and Lung Transplantation, Vol. 38, No. 4, 01.04.2019, p. 352-363.

Research output: Contribution to journalArticle

Goldstein, Daniel J. ; Meyns, Bart ; Xie, Rongbing ; Cowger, Jennifer ; Pettit, Stephen ; Nakatani, Takeshi ; Netuka, Ivan ; Shaw, Steven ; Yanase, Masanobu ; Kirklin, James K. / Third Annual Report From the ISHLT Mechanically Assisted Circulatory Support Registry : A comparison of centrifugal and axial continuous-flow left ventricular assist devices. In: Journal of Heart and Lung Transplantation. 2019 ; Vol. 38, No. 4. pp. 352-363.
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AU - Cowger, Jennifer

AU - Pettit, Stephen

AU - Nakatani, Takeshi

AU - Netuka, Ivan

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AU - Yanase, Masanobu

AU - Kirklin, James K.

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AB - 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.

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