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. Author manuscript; available in PMC: 2023 Mar 1.
Published in final edited form as: Ann Thorac Surg. 2022 Jan 7;113(3):722–737. doi: 10.1016/j.athoracsur.2021.12.011

Table 4:

The Society of Thoracic Surgery - Interagency Registry for Mechanically Assisted Circulatory Support Research Publications from 2020

Study Title Aim Key Findings
Differences in health-related quality of life by implant strategy: Analyses from the Interagency Registry for Mechanically Assisted Circulatory Support (White-Williams et al, J Heart Lung Transplant)(22) To examine differences in Health-Related Quality of Life (HRQOL) based on EQ-5D-3L and KCCQ-12 questionnaires between preop and 2 years postimplant time periods. The analysis was stratified by pre-operative left ventricular assist device (LVAD) implant strategy. This study provides overall and domain-specific evidence of differences in HRQOL both cross-sectionally and over time by implant strategy. Overall HRQOL was poor before MCS implantation and significantly improved through 2 years after surgery, regardless of implant strategy. Notably, some cross-sectional differences by group in overall HRQOL before and midterm after implant were not always clinically meaningful. Significant differences were detected in HRQOL domain scores by implant strategy, using both generic and heart failure–specific instruments. Understanding HRQOL may assist patients and caregivers with shared decision-making when considering MCS as a treatment option and provide guidance for healthcare clinicians to develop targeted interventions to improve post-implant HRQOL.
Extracorporeal Membrane Oxygenation as a Bridge to Durable Mechanical Circulatory Support: An Analysis of the STS Intermacs Database (Loyaga-Rendon et al, Circ Heart Fail)(23) To compare the clinical characteristics, outcomes, and risk factors for poor outcomes among Intermacs Profile 1 patients who are supported by extracorporeal membrane oxygenation (ECMO) as a bridge to durable MCS. This propensity matched analysis showed that Intermacs Profile 1 patients bridged on ECMO to LVAD had lower survival than those without ECMO. The proportion of patients successfully bridged to transplantation after LVAD over 2 year follow up was similar between groups. The highest hazard of death occurred in the first 6 months post-implantation and ECMO use was an independent risk factor for poor outcome. In a selected group of ECMO supported patients, the survival was similar to equally ill matched patients. Multiple identified risk factors can help in patient risk stratification. These data support the implantation of LVADs in carefully selected ECMO patients.
Identifying Temporal Relationships Between in-Hospital Adverse Events After Implantation of Durable Left Ventricular Assist Devices (Kilic et al, J Amer Heart Assoc)(24) To examine the impact of specific perioperative adverse events (AEs) on subsequent AEs after LVAD implantation. This study, which relied on risk-adjusted Cox proportional hazard models of temporal relationships between AEs, demonstrated that index hospitalization AEs following LVAD implant are significantly associated with the development of subsequent AEs. Specific sequences and patterns of AE were identified. The most profound impact was found to be with a primary respiratory or renal failure AE. Targeted efforts to reduce the incidence of these two highly morbid AEs may be useful in reducing the overall AE burden and subsequent mortality in the LVAD patient population.
Postimplant Phosphodiesterase Type 5 Inhibitors Use Is Associated With Lower Rates of Thrombotic Events After Left Ventricular Assist Device Implantation (Xanthopoulos et al, J Amer Heart Assoc)(25) To examine whether the postimplant use of Phosphodiesterase type 5 (PDE-5) inhibitors is associated with a lower incidence of thrombotic events (composite of pump thrombosis and ischemic stroke) in a Intermacs LVAD population. The postimplant use of a PDE-5 inhibitor was associated with a significant reduction in thrombotic events, and in both of the components (pump thrombus, ischemic stroke) separately. In addition, PDE-5 inhibitor use was associated with a reduction in all-cause mortality at 48-months postoperatively. A randomized clinical trial to confirm these salutary effects is warranted.
Quantifying the impact from stroke during support with continuous flow ventricular assist devices: An STS Intermacs analysis (Kirklin et al, J Heart Lung Transplant)(26) To analyze the incidence, recurrence, risk factors for, and outcomes after stroke on CF-LVAD devices in STS Intermacs. This study confirms the 20% incidence of stroke over the first 2 years with the axial flow and non-magnetically levitated centrifugal flow pumps. Patients are somewhat more susceptible to a subsequent ischemic stroke after the first one. The 6-month mortality is >30% after an ischemic stroke and >50% after a hemorrhagic stroke. Based on a limited sub-group of patients with Modified Rankin Score (MRS) data available, only about one-third of patients with major disability showed improvement between 1 and 3 months, and this study suggests a major increase in 1- and 2-year mortality among those with an initial disabling stroke. Better reporting of longitudinal MRS and HRQOL data after a stroke are warranted.
Right Atrial Pressure Predicts Mortality Among LVAD Recipients: Analysis of the Intermacs Database (Guglin et al, Heart Lung Circ)(27) To identify preoperative hemodynamic predictors of all-cause mortality. Standard right heart catheterization hemodynamic variables were compared to find which variable is superior in predicting mortality. Significant variables were examined longitudinally to see their ability to predict short, intermediate, and long-term mortality. In general, hemodynamic variables, as well as other criteria including Intermacs profiles, were found to be weak predictors of mortality after LVAD. Right atrial pressure (RAP) is the only consistent and significant hemodynamic predictor of mortality in LVAD recipients, independent of Intermacs profile. A RAP ≥ 13mmHg was found to be optimal cutoff for prediction of mortality after implant. RAP remains a significant predictor of mortality during the 1st year of LVAD support.

AE, adverse event; ECMO, extracorporeal membranous oxygenation; EQ-5D-3L, 3-level version of EQ-5D and consists of the EQ-5D descriptive system and the EQ visual analogue scale; KCCQ-12, Kansas City Cardiomyopathy Questionnaire short version; HRQOL, Health-Related Quality of Life; LVAD, left ventricular assist device; MCS, mechanical circulatory support; MRS, modified rankin score; PDE-5, phosphodiesterase type 5; RAP, right atrial pressure.