First Italian multicentre registry for Mechanically Assisted Circulatory Support (ITAMACS) report: 12-year experience of over 1000 durable LVAD patients

Aims: Left ventricular assist device (LVAD) implantation is an established therapy for advanced heart failure, either as bridge-to-transplantation (BTT) or destination therapy (DT). The Italian National Transplant Center supported the development of the Italian multicentre registry for mechanically assisted circulatory support (ITAMACS). We report the first analysis of the ITAMACS registry, focusing on durable intracorporeal LVADs. Methods: All durable LVAD implantations performed in Italy between January 2010 and December 2021 were collected, including follow-up data, and submitted by participating centres to a centralized database. Demographic characteristics, procedural variables, and clinical outcomes were analysed. Survival was assessed using Kaplan-Meier analysis, and Cox proportional hazards models were used to identify independent predictors of long-term mortality. Results: A total of 1061 patients from 12 centres underwent durable LVAD implantation. BTT was the indication in 40.5% and DT in 38.8% of cases; 14.8% of patients were in INTERMACS class 1, and 16.3% underwent minimally invasive implantation. Overall survival at 1, 3, and 5 years was 73%, 54%, and 42%, respectively. On multivariable analysis, older age (hazard ratio [HR] 1.02, 95% confidence interval [CI] 1.01-1.04) and redo surgery (HR 1.25, 95% CI 1.02-1.55) were associated with higher mortality, whereas INTERMACS class >1 (HR 0.66, 95% CI 0.50-0.87) and BTT indication (HR 0.63, 95% CI 0.48-0.83) were protective. Conclusion: ITAMACS is the first national registry reporting real-world outcomes of durable LVAD therapy in Italy. These data provide an overview of national practice and may support optimization of LVAD programs and patient care.