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.

Azienda Ospedaliera San Camillo Forlanini Rome Italy

Cardiothoracic Dept AHEPA University Hospital Aristotle University Thessaloniki Greece

Center for Cardiovascular Surgery and Transplantation Surgery Brno Brno Czech Republic

Clinica Universidad de Navarra Pamplona Spain

Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany

Department of Cardiovascular Surgery University Hospital Freiburg Freiburg Germany

DZHK Partner Site Berlin Germany

Ege University Hospital Izmir Turkey

ESPAMACS Sociedad Española de Cirugía Cardiovascular y Endovascular Madrid Spain

EUROMACS EACTS House Windsor UK

Heart Center of the Semmelweis University Budapest Hungary

Herz und Diabeteszentrum NRW Bad Oeynhausen Germany

HerzZentrum Hirslanden Zürich Switzerland

Herzzentrum Leipzig Leipzig Germany

Institute for Clinical and Experimental Medicine Prague Czech Republic

Katholieke Universiteit Leuven Leuven Belgium

Klinika Kardiochirurgie NUSCH Bratislava Slovakia

Leiden University Medical Center Leiden Netherlands

Medical Faculty of the Albert Ludwigs University Freiburg Germany

National Research Cardiac Surgery Center Astana Kazakhstan

Onassis Cardiac Surgery Center Athens Greece

Onze Lieve Vrouwenziekenhuis Aalst Belgium

Ospedale Papa Giovanni XIII Bergamo Italy

Prince Sultan Cardiac Center Al Hassa Saudi Arabia

Rigshospitalet Copenhagen Denmark

Rikshospitalet Oslo Norway

San Orsola Hospital Bologna Italy

Silesian Center for Heart Diseases Zabrze Poland

Thorax Center Department of Cardiology Erasmus University Medical Center Rotterdam Netherlands

Universitair Medisch Centrum Groningen Groningen Netherlands

Universitäres Herzzentrum Hamburg Hamburg Germany

Universitätskliniken Innsbruck Innsbruck Austria

Universitätsklinikum Köln AöR Köln Germany

University Hospital Bern Bern Switzerland

University Hospital Zürich Zürich Switzerland

Utrecht University Medical Center Utrecht Netherlands

Vienna Medical University Vienna Austria

Eur J Cardiothorac Surg. 2022 Jun 15;62(1):ezac062. doi: 10.1093/ejcts/ezac062. PubMed

Eur J Cardiothorac Surg. 2022 Jun 15;62(1):ezac350. doi: 10.1093/ejcts/ezac350. PubMed

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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

Left ventricular assist device-related infections and the risk of cerebrovascular accidents: a EUROMACS study