Mechanical circulatory support in patients with congenital heart disease: a european registry for patients with mechanical circulatory support (EUROMACS) study.

Abstract

This study aims to explore characteristics and clinical outcomes of patients with congenital heart disease (CHD) in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). This is a retrospective study of EUROMACS participants receiving MCS as bridge-to-transplant, possible bridge-to-transplant, or rescue therapy/bridge-to-recovery from 2011 to 2023 (n = 5,340). Adult and paediatric cohorts were analysed separately. The primary outcome was mortality on MCS; secondary outcomes included recovery, transplant and complications including bleeding, cerebrovascular events, and sepsis. Among adult patients, mortality at 1-year was 33.3% among the CHD cohort versus 22.1% in the non-CHD cohort. Adult CHD patients had higher hazards of mortality within the first year after MCS implantation (HR 1.98 95% CI 1.35-2.91, p < 0.001) and bleeding events (sdHR 2.10, 95% CI 1.40-3.16, p < 0.001) compared with non-CHD patients. Both associations remained significant after accounting for multiple mediators. Among paediatric patients, mortality at 1-year was 22.1% in the CHD cohort versus 17.3% in the non-CHD cohort (HR 1.39 95% CI 0.83-2.32, p = 0.213). Adult and paediatric patients with CHD on MCS have higher adverse event risk compared with non-CHD MCS patients, though children did not have greater risk of mortality. As the number of CHD patients requiring advanced heart failure management continues to grow, these findings can enhance informed decision-making.