Challenges, Risk Factors, and Outcomes with Long Term Mechanical Circulatory Support

With the introduction of durable continuous flow (CF) mechanical circulatory support (MCS) pumps in the first decade of the twenty-first century, the application of MCS rapidly expanded. The U.S. National Heart, Lung, and Blood Institute of the National Institutes of Health sought to develop a national scientific registry for durable MCS devices, culminating in the creation of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS). Data collection began in 2006, and currently >170 hospitals provide complete durable device data, representing >95% of US durable device implants. Since 2010, more than 27,000 MCS durable devices have been implanted in the U.S., of which >95% have been CF devices. INTERMACS levels of advanced heart failure recognize severity ranging from critical cardiogenic shock (level 1) to ambulatory advanced heart failure (levels 4–7). A comprehensive INTERMACS analysis identified numerous predictors of early and midterm mortality. Among demographic factors, older age, female gender, and larger BMI have been identified as risk factors for early mortality. CF LVADs have produced gradual improvement in survival over the past 5 years, major adverse events continue to be major impediment to long term application, and quality of life is generally good out to 5 years.