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 = 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.

Cardiac Surgery and Heart Transplantation Unit Azienda Ospedaliera San Camillo Forlanini Rome Italy

Cardiology and Cardiac Surgery Department Clinica Universidad de Navarra Pamplona Spain

Cardiothoracic Department Aristotle University AHEPA University Hospital Thessaloniki Greece

Department for Cardiothoracic Surgery Heart Center Universitätsklinikum Köln AöR Köln Germany

Department of Anesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milano Italy

Department of Cardiac Surgery Helsinki University Hospital Helsinki Finland

Department of Cardiac Surgery Herzzentrum Leipzig Leipzig Germany

Department of Cardiac Surgery Katholieke Universiteit Leuven Leuven Belgium

Department of Cardiac Surgery Klinika Kardiochirurgie NUSCH Bratislava Slovakia

Department of Cardiac Surgery Medical University of Innsbruck Innsbruck Austria

Department of Cardiac Surgery Saarland University Medical Center Homburg Germany

Department of Cardiac Surgery University Hospital Basel Basel Switzerland

Department of Cardiac Surgery Vienna Medical University Vienna Austria

Department of Cardiology Arhus University Hospital Arhus Denmark

Department of Cardiology Heart Center of the Semmelweis University

Department of Cardiology Leiden University Medical Center Leiden Netherlands

Department of Cardiology Thorax Center Cardiovascular Institute Erasmus MC University Medical Center Rotterdam Netherlands

Department of Cardiothoracic and Vascular Surgery Deutsches Herzzentrum der Charité Berlin Germany

Department of Cardiothoracic Surgery Erasmus MC Rotterdam The Netherlands

Department of Cardiothoracic Surgery Rikshospitalet Oslo Norway

Department of Cardiothoracic Surgery Utrecht University Medical Center Utrecht Netherlands

Department of Cardiothoracic Transplantation and Vascular Surgery Azienda Ospedaliero Universitaria Citta della Salute e della Scienza Torino Turin Italy

Department of Cardiovascular Surgery and Transplantations Center for Cardiovascular Surgery and Transplantation Surgery Brno Czech Republic

Department of Cardiovascular Surgery Ege University Hospital Izmir Turkey

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine Prague Czech Republic

Department of Cardiovascular Surgery Onze Lieve Vrouwenziekenhuis Aalst Belgium

Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany

Department of Cardiovascular Surgery University Hospital Bern Switzerland

Department of Cardiovascular Surgery University Hospital Freiburg Freiburg Germany

Department of Cardiovascular surgery University Hospital Hamburg Eppendorf Hamburg Germany

Department of Medicine Karolinska University Hospital Stockholm Sweden

Department of Thoracic and Cardiovascular Surgery Herz und Diabeteszentrum NRW Bad Oeynhausen Germany

Department of Transplant Surgery and Surgical Treatment of Heart Failure Ospedale Papa Giovanni XIII Bergamo Italy

DZHK Berlin Germany

EUROMACS EACTS House Windsor UK

IRCCS AOU di Bologna Sant'Orsola Dept of cardiac surgery San Orsola Hospital Bologna Italy

National Research Cardiac Surgery Center Astana Kazakhstan

Onassis Cardiac Surgery Center Athens Greece

Silesian Center for Heart Diseases Zabrze Poland

Universitair Medisch Centrum Groningen University of Groningen Groningen Netherlands

Universitäts Herzzentrum Thüringen Jena Germany

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