Purpose: Superior survival outcomes have been reported for younger LVAD patients (<50 yrs) in INTERMACS. We explored whether this is true in european practice leveraging on EUROMACS (European Registry for Patients with Mechanical Circulatory Support). Methods: Patients with current MagLev LVAD support in EUROMACS were stratified according to age. Primary outcome was the Kaplan Meier estimate of on-device survival up to 5 years censoring at heart transplant (HT) or support cessation. Secondary outcomes were on-device survival free from bleeding, device malfunction, stroke, or device-related infection. Death incidence accounting for HT and support cessation as competing risks was calculated. Results: 2850 patients undergoing HeartMate 3 implant were included (<50 yrs 23.5%; 50-59 yrs 29.7%; 60-69 yrs 38.0%; ≥70 yrs 8.8%). Younger patients had less comorbidities, more frequent non-ischemic cardiomyopathy and INTERMACS profile ≤3, without gender differences. Younger patients had superior on-device 5-yr survival (<50 yrs 74.7%; 50-59 yrs 65.2%; 60-69 yrs 53.9%; ≥70 yrs 48.8%, p<0.001). Accounting for competitive outcomes, the 5-yr cumulative incidence of death was significantly lower: <50 yrs 20.5%; 50-59 yrs 28.0%; 60-69 yrs 38.7%; ≥70 yrs 48.1%, p<0.001. Survival free from bleeding (<50 yrs 70.2%; 50-59 yrs 67.6%; 60-69 yrs 63.3%; ≥70 yrs 56.9%, p<0.001) was improved, while no difference in survival free from stroke (<50 yrs 89%; 50-59 yrs 88.4%; 60-69 yrs 87.9%; ≥70 yrs 86.2%, p=0.693), device infection (<50 yrs 42.3%; 50-59 yrs: 42.1%; 60-69 yrs 47.2%; ≥70 yrs 48.2%, p=0.554) and device malfunction (<50 yrs 73.2%; 50-59 yrs 72.3%; 60-69 yrs 77.2%; ≥70 yrs 73.5%, p=0.492) were observed. Among younger patients, the mortality was unaffected by age, gender and race. Conclusion: In EUROMACS, patients <50 yrs had high 5-yr on-device survival comparable to that of patients listed for HT. These data support exploration of prolonged LVAD support before HT in younger candidates to achieve a potential net survival gain.
Long Term Outcomes of Contemporary Durable LVAD Support in Younger Patients - An EUROMACS Analysis
Gallone G;Spitaleri A;De Ferrari GM;Rinaldi M;Loforte A.
2026-01-01
Abstract
Purpose: Superior survival outcomes have been reported for younger LVAD patients (<50 yrs) in INTERMACS. We explored whether this is true in european practice leveraging on EUROMACS (European Registry for Patients with Mechanical Circulatory Support). Methods: Patients with current MagLev LVAD support in EUROMACS were stratified according to age. Primary outcome was the Kaplan Meier estimate of on-device survival up to 5 years censoring at heart transplant (HT) or support cessation. Secondary outcomes were on-device survival free from bleeding, device malfunction, stroke, or device-related infection. Death incidence accounting for HT and support cessation as competing risks was calculated. Results: 2850 patients undergoing HeartMate 3 implant were included (<50 yrs 23.5%; 50-59 yrs 29.7%; 60-69 yrs 38.0%; ≥70 yrs 8.8%). Younger patients had less comorbidities, more frequent non-ischemic cardiomyopathy and INTERMACS profile ≤3, without gender differences. Younger patients had superior on-device 5-yr survival (<50 yrs 74.7%; 50-59 yrs 65.2%; 60-69 yrs 53.9%; ≥70 yrs 48.8%, p<0.001). Accounting for competitive outcomes, the 5-yr cumulative incidence of death was significantly lower: <50 yrs 20.5%; 50-59 yrs 28.0%; 60-69 yrs 38.7%; ≥70 yrs 48.1%, p<0.001. Survival free from bleeding (<50 yrs 70.2%; 50-59 yrs 67.6%; 60-69 yrs 63.3%; ≥70 yrs 56.9%, p<0.001) was improved, while no difference in survival free from stroke (<50 yrs 89%; 50-59 yrs 88.4%; 60-69 yrs 87.9%; ≥70 yrs 86.2%, p=0.693), device infection (<50 yrs 42.3%; 50-59 yrs: 42.1%; 60-69 yrs 47.2%; ≥70 yrs 48.2%, p=0.554) and device malfunction (<50 yrs 73.2%; 50-59 yrs 72.3%; 60-69 yrs 77.2%; ≥70 yrs 73.5%, p=0.492) were observed. Among younger patients, the mortality was unaffected by age, gender and race. Conclusion: In EUROMACS, patients <50 yrs had high 5-yr on-device survival comparable to that of patients listed for HT. These data support exploration of prolonged LVAD support before HT in younger candidates to achieve a potential net survival gain.
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