TY - JOUR
T1 - The Society of Thoracic Surgeons Intermacs 2019 Annual Report
T2 - The Changing Landscape of Devices and Indications
AU - Teuteberg, Jeffrey J.
AU - Cleveland, Joseph C.
AU - Cowger, Jennifer
AU - Higgins, Robert S.
AU - Goldstein, Daniel J.
AU - Keebler, Mary
AU - Kirklin, James K.
AU - Myers, Susan L.
AU - Salerno, Christopher T.
AU - Stehlik, Josef
AU - Fernandez, Felix
AU - Badhwar, Vinay
AU - Pagani, Francis D.
AU - Atluri, Pavan
N1 - Publisher Copyright:
© 2020 The Society of Thoracic Surgeons
PY - 2020/3
Y1 - 2020/3
N2 - Background: The field of mechanical circulatory support has been impacted by the approval of new continuous-flow left ventricular assist devices (LVADs) and changes to the United States heart allocation system. Methods: Primary isolated continuous-flow LVAD implants in The Society of Thoracic Surgeons Intermacs registry from January 2014 through September 2019 were evaluated. Survival and freedom from major adverse events were compared between axial-flow, centrifugal-flow with hybrid levitation (CF-HL), and centrifugal-flow with full magnetic levitation (CF-FML) devices. Results: Of 2603 devices implanted in 2014, 1824 (70.1%) were axial flow and 1213 (46.6%) were destination therapy (DT); through September 2019, 1752 devices were implanted, but only 37 (2.1%) were axial flow and 1230 (70.2%) were DT. Implants were performed in 13,016 patients between 2014 and 2018. Patients receiving implants in 2017-2018 compared with 2014-2016 were more likely to be at Intermacs profile 1 (17.1% vs 14.3%, P < .001) and to have preimplant temporary mechanical circulatory support (34.8% vs 29.3%, P < .001). Overall survival and freedom from major adverse events were higher with CF-FML devices. In multivariable analysis of survival between CF-HL and CF-FML, device type was not a significant early hazard, but the use of CF-HL devices had a late hazard ratio for death of 3.01 (P < .001). Conclusions: Over the past 5 years, centrifugal-flow LVADs have become the dominant technology and DT the most common implant strategy. While outcomes with CF-FML devices are promising, comparisons with other devices from nonrandomized registry studies should be made with caution.
AB - Background: The field of mechanical circulatory support has been impacted by the approval of new continuous-flow left ventricular assist devices (LVADs) and changes to the United States heart allocation system. Methods: Primary isolated continuous-flow LVAD implants in The Society of Thoracic Surgeons Intermacs registry from January 2014 through September 2019 were evaluated. Survival and freedom from major adverse events were compared between axial-flow, centrifugal-flow with hybrid levitation (CF-HL), and centrifugal-flow with full magnetic levitation (CF-FML) devices. Results: Of 2603 devices implanted in 2014, 1824 (70.1%) were axial flow and 1213 (46.6%) were destination therapy (DT); through September 2019, 1752 devices were implanted, but only 37 (2.1%) were axial flow and 1230 (70.2%) were DT. Implants were performed in 13,016 patients between 2014 and 2018. Patients receiving implants in 2017-2018 compared with 2014-2016 were more likely to be at Intermacs profile 1 (17.1% vs 14.3%, P < .001) and to have preimplant temporary mechanical circulatory support (34.8% vs 29.3%, P < .001). Overall survival and freedom from major adverse events were higher with CF-FML devices. In multivariable analysis of survival between CF-HL and CF-FML, device type was not a significant early hazard, but the use of CF-HL devices had a late hazard ratio for death of 3.01 (P < .001). Conclusions: Over the past 5 years, centrifugal-flow LVADs have become the dominant technology and DT the most common implant strategy. While outcomes with CF-FML devices are promising, comparisons with other devices from nonrandomized registry studies should be made with caution.
UR - http://www.scopus.com/inward/record.url?scp=85080053084&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85080053084&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2019.12.005
DO - 10.1016/j.athoracsur.2019.12.005
M3 - Article
C2 - 32115073
AN - SCOPUS:85080053084
SN - 0003-4975
VL - 109
SP - 649
EP - 660
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -