Test: Impact of Preoperative Temporary Mechanical Circulatory Support on Durable LVAD Outcomes An Analysis of The Society of Thoracic Surgeons National Intermacs Database

Background

Objective: Assess impact of preoperative temporary mechanical circulatory support on durable LVAD (HM3) outcomes.

Methods: Adults with INTERMACS 1–3 profilesundergoing HeartMate 3 implantation (2020–2024) were analyzed from the STS INTERMACS database. Survival and stroke outcomes were compared across no tMCS, IABP, Impella 5.0/5.5 (HF-MP), and VA-ECMO cohorts using multivariable and propensity-matched analyses.

Results: Among 5,787 LVAD recipients, two-thirds were bridged with temporary MCS, with Impella 5.0/5.5 useincreasing significantly over time. Impella and IABP support were associated with improved survival compared with no tMCS, while ECMO had the worst
outcomes; importantly, Impella support improvedsurvival without increasing stroke risk after propensity matching.

Conclusion: Bridging with HF-MP before LVAD is associated with favorable survival without excess stroke.

Analysis

Reviewer’s Comments

Largest contemporary HM3 registry analysis.

HF-MP use increased substantially over study period.

HF-MP bridge associated with improved survival versus no tMCS.

Supports aggressive stabilization before durable LVAD implantation.

Findings align with growing Impella-to-LVAD experience

Limitations

Retrospective registry study.

Residual confounding despite propensity matching.

Device selection bias likely.

No granular data on management strategies.

Follow-up limited to 2 years.