Regional Outcomes after Continuous-Flow Left Ventricular Assist Device: An IMACS Analysis.

Purpose: Regional outcomes after implantation of continuous flow left ventricular assist devices (LVAD) have not been described. We examined differences in patient selection, outcomes and adverse events (AEs) in LVADs across three geographic regions of the World: Americas (AM), Asia-Pacific (AP) and Europe (EU). Methods: Using data from The International Society for Heart and Lung Transplantation (ISHLT) Mechanically Assisted Circulatory Support (IMACS) registry all patients with an LVAD were included in this study (N=15,560) of whom n=9,988 received an axial flow (Ax) and n=5,572 received a centrifugal flow (Centr) device. Results: In AM, more patients older than 70 years (AM 14%, AP 1 %, EU 5%, P\u3c0.0001) and morbidly obese (AM 5%, AP 1%, EU 1%, P \u3c0.0001) were implanted. In EU more LVAD recipients were male (EU 85%, AM 79%, AP 77%, P \u3c0.0001), and more Centr. pumps were implanted (AM 30%, AP 34%, EU 74%, P\u3c.0001). Destination therapy was more common in AM than outside AM (AM 48%, AP 4%, EU 22%, P \u3c0.0001). Adverse events (AE) exhibited regional variation: gastrointestinal bleeding was the most common AE in AM (47%) and device specific infection was most common in AP (46%) and EU (20%). Survival rates for Ax vs Centr flow pumps at 12, 24 and 48 months were: Am 82% vs 82%, 71% vs 72%, 52% vs 53; AP 92% vs 86%, 89% vs 80%, 83% vs 74%; EU 80% vs 75%, 75% vs 66%, 69% vs 53% (P\u3c0.0001), see figure 1. Length of hospitalization (LOS) was 25±32, 82±70 and 43±42 days, in AM, AP and EU, respectively (P\u3c0.0001). Conclusion: Patient age, weight, device strategy, use of flow pump types (Ax/Centr), LOS and AEs varied between EU, AP and AM. Extended survival (\u3e3 years) was more frequent in AP. Regional differences in AE incidence warrant further investigation