Long-Term Outcomes of Contemporary Durable Left Ventricular Assist Device Support in Younger Patients: A EUROMACS Analysis
Abstract
Objectives: Superior survival outcomes have been reported for younger patients receiving durable left ventricular assist devices (LVADs) in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). We explored whether these findings extend to contemporary European practice leveraging on EUROMACS (European Registry for Patients with Mechanical Circulatory Support).
Methods: Adult patients undergoing implantation of current-generation magnetically levitated LVADs in EUROMACS were stratified according to age groups. The primary outcome was 5-year on-device survival, censored at heart transplantation (HT) or LVAD explantation. Secondary outcomes included LVAD explant for myocardial recovery and survival free from major adverse events (bleeding, stroke, device-related infection, or device malfunction). Death incidence accounting for HT and support cessation as competing risks was also calculated.
Results: A total of 2850 patients undergoing HeartMate 3 implantation were included (<50 years: 23.5%; 50-59 years: 29.7%; 60-69 years: 38.0%; ≥70 years: 8.8%). Younger patients had fewer comorbidities, a higher prevalence of non-ischaemic cardiomyopathy, and INTERMACS profile ≤3. Younger patients had superior on-device 5-year survival (<50 years: 74.7%; 50-59 years: 65.5%; 60-69 years: 53.9%; ≥70 years: 48.8%; P < .001) and LVAD explantation for myocardial recovery (<50 years: 4.3%; 50-59 years: 1.8%; 60-69 years: 2.3%; ≥70 years: 0.4%; P = .031). Accounting for competing outcomes, the 5-year cumulative incidence of death was lowest among younger patients (<50 years: 20.8%; 50-59 years: 29.1%; 60-69 years: 40.8%; ≥70 years: 49.5%; P < .001), driven by higher HT rates. Survival free from bleeding was significantly higher in younger patients (P < .001). In contrast, 5-year freedom from stroke, device-related infection, and device malfunction was similar across age groups.
Conclusions: In contemporary European practice, patients <50 years undergoing LVAD implant had high 5-year survival approaching that reported in cohorts of patients listed for HT. These findings support further investigation of prolonged LVAD support before HT as a potential strategy to maximize lifetime benefit in selected motivated younger candidates.
Related
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- The interaction of age and time on durable left ventricular assist device and its effect on heart transplant outcomes.
- Six-Minute Walk Distance and Long-Term Outcomes in Contemporary Left Ventricular Assist Device Recipients: The ELEVATE Registry
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BibTeX
@article{gallone2026longterm,
title = {{Long-Term Outcomes of Contemporary Durable Left Ventricular Assist Device Support in Younger Patients: A EUROMACS Analysis}},
author = {Guglielmo Gallone and Kevin M Veen and Alexander M Bernhardt and Kadir Caliskan and Emil Najjar and Ivan Netuka and Anna Mara Scandroglio and Antonio Spitaleri and Diego Sangiorgi and Peter Ivak and Arnt Fiane and Feras Khaliel and Mustafa Özbaran and Yuri Pya and Daniel Zimpfer and Gloria Färber and Jan Gummert and Bart Meyns and Paola Quattroni and Felix Schoenrath and Gaetano Maria De Ferrari and Mauro Rinaldi and Evgenij Potapov and Antonio Loforte},
journal = {European Journal of Cardio-Thoracic Surgery},
year = {2026},
month = oct,
doi = {10.1093/ejcts/ezag234},
url = {https://doi.org/10.1093/ejcts/ezag234},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Long-Term Outcomes of Contemporary Durable Left Ventricular Assist Device Support in Younger Patients: A EUROMACS Analysis
AU - Guglielmo Gallone
AU - Kevin M Veen
AU - Alexander M Bernhardt
AU - Kadir Caliskan
AU - Emil Najjar
AU - Ivan Netuka
AU - Anna Mara Scandroglio
AU - Antonio Spitaleri
AU - Diego Sangiorgi
AU - Peter Ivak
AU - Arnt Fiane
AU - Feras Khaliel
AU - Mustafa Özbaran
AU - Yuri Pya
AU - Daniel Zimpfer
AU - Gloria Färber
AU - Jan Gummert
AU - Bart Meyns
AU - Paola Quattroni
AU - Felix Schoenrath
AU - Gaetano Maria De Ferrari
AU - Mauro Rinaldi
AU - Evgenij Potapov
AU - Antonio Loforte
PY - 2026
DA - 2026/10/07
JO - European Journal of Cardio-Thoracic Surgery
DO - 10.1093/ejcts/ezag234
UR - https://doi.org/10.1093/ejcts/ezag234
AB - Objectives: Superior survival outcomes have been reported for younger patients receiving durable left ventricular assist devices (LVADs) in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). We explored whether these findings extend to contemporary European practice leveraging on EUROMACS (European Registry for Patients with Mechanical Circulatory Support). Methods: Adult patients undergoing implantation of current-generation magnetically levitated LVADs in EUROMACS were stratified according to age groups. The primary outcome was 5-year on-device survival, censored at heart transplantation (HT) or LVAD explantation. Secondary outcomes included LVAD explant for myocardial recovery and survival free from major adverse events (bleeding, stroke, device-related infection, or device malfunction). Death incidence accounting for HT and support cessation as competing risks was also calculated. Results: A total of 2850 patients undergoing HeartMate 3 implantation were included (<50 years: 23.5%; 50-59 years: 29.7%; 60-69 years: 38.0%; ≥70 years: 8.8%). Younger patients had fewer comorbidities, a higher prevalence of non-ischaemic cardiomyopathy, and INTERMACS profile ≤3. Younger patients had superior on-device 5-year survival (<50 years: 74.7%; 50-59 years: 65.5%; 60-69 years: 53.9%; ≥70 years: 48.8%; P < .001) and LVAD explantation for myocardial recovery (<50 years: 4.3%; 50-59 years: 1.8%; 60-69 years: 2.3%; ≥70 years: 0.4%; P = .031). Accounting for competing outcomes, the 5-year cumulative incidence of death was lowest among younger patients (<50 years: 20.8%; 50-59 years: 29.1%; 60-69 years: 40.8%; ≥70 years: 49.5%; P < .001), driven by higher HT rates. Survival free from bleeding was significantly higher in younger patients (P < .001). In contrast, 5-year freedom from stroke, device-related infection, and device malfunction was similar across age groups. Conclusions: In contemporary European practice, patients <50 years undergoing LVAD implant had high 5-year survival approaching that reported in cohorts of patients listed for HT. These findings support further investigation of prolonged LVAD support before HT as a potential strategy to maximize lifetime benefit in selected motivated younger candidates.
SN - 1010-7940
SN - 1873-734X
ER -