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IMACS and the Global Evolution of Mechanical Circulatory Support

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James Kirklin, MD
University of Alabama
Birmingham, AL, USA

After three years of global data collection, the ISHLT Registry for Mechanical Circulatory Support (IMACS) is poised to report the global evolution of Mechanical Circulatory Support (MCS) therapies. Thirty-one countries are currently represented in the IMACS database (Figure 1).links image Total patient enrollment now exceeds 10,000 patients, supporting the IMACS mission of promoting scientific investigations and publications based on analyses of the international MCS experience. Nearly one-third of patients are actively listed for transplantation, whereas over 40% received a durable device with the intention of long-term or "destination" therapy. Isolated left ventricular support has been utilized in over 90% of patients. The most common age group is 50 to 69 years, accounting for nearly 60% of patients. More than 80% of patients at the time of implant are inotrope dependent and often in rapid circulatory decline. Penetration into ambulatory heart failure has been limited, accounting for less than 5% of patients at implant.

The overall survival of 80% at one year and 70% at two years reflects the improved outcomes experienced world-wide with current generation continuous flow pumps. The primary causes of mortality are multi-organ failure, complications of right heart failure, and neurologic events. Bleeding and infection are the major adverse events both within the first three months and later. Analyzing the first 2 years of follow-up, the greatest risk of mortality occurs within the first 3 months after implant, with a constant phase of risk thereafter out to about 2 years (Figure 2).links image Older age, higher body mass index, INTERMACS profiles 1 and 2, the need for bi-ventricular support, a smaller left ventricular cavity size, concomitant cardiac surgery, poor nutritional state, renal dysfunction, and hepatic dysfunction were identified as risk factors for early mortality.

The IMACS analysis noted that elderly patients, particularly over about age 65, are especially vulnerable to the added risk of major associated comorbidities and/or circulatory collapse at the time of implant. The risk of death within the first year is nearly twice as high for a 70 year old compared to a 40 year old patient in the presence of renal failure, cardiogenic shock, or the need for bi-ventricular support.

The entire IMACS team wishes to give special thanks to all of the contributing IMACS hospitals and the collectives from EUROMACS, JMACS, INTERMACS, and the United Kingdom for supplying their patient data to ISHLT. Our goals for the coming year focus on expanding the number of enrolling hospitals and collectives and enhancing IMACS research under the purview of our IMACS Research Sub-committee (Chair, Jennifer Cowger). For anyone wishing further information about participation in IMACS, please refer to our website at www.ISHLT.org/registries or email us at: IMACS@uabmc.edu. Telephone inquiries can be made at 205-975-3906. ■

Disclosure Statement: The author has no conflicts of interest to disclose.

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