Worldwide Gender Differences during Mechanical Circulatory Support: An Analysis of the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support Registry Data

Abstract

The aim of this study is to investigate gender differences of patients on mechanical circulatory support (MCS) using data of the International Society for Heart and Lung Transplantation (ISHLT) Mechanically Assisted Circulatory Support (IMACS) registry. We hypothesize that gender differences lead to differences in implantation data, perioperative complication rates as well as in mid- and longterm outcome among patients undergoing MCS therapy and that these outcomes differ between continents. The study was performed using the IMACS registry database of the International Society for Heart and Lung Transplantation.Patients receiving right (temporary or permanent) or left ventricular assist devices and patients with biventricular assist devices were included leading to a total number of 17329 patients. For each computation, only cases without missing values on the variables involved in that particular analysis were analyzed. We included 17329 patients who underwent MCS, either with left ventricular support only or additional right ventricular support. Mean patients age was 54.2 ± 15.4 years and did not differ significantly between the two groups. The majority of the patients was male (78.2%). In both groups most of the devices were implanted to bridge the patients to transplantation (60.5% female vs 57.9% male). There was a significant difference regarding need of temporary right ventricular support (2.6% female vs 2 % male; p=0.048) and women underwent significantly more frequent implantation of biventricular mechanical support (6.6% female vs 4.6% male; p< 0.001). There was no significant difference for the occurrence of bleeding events in general but women showed more intra-abdominal and urinary tract associated bleeding complications (2.8% female vs 2.4% male; p= 0.025). The rate of pump thrombosis was significantly higher in the male patient group with 1.3% vs 0.8% among female patients (p=0.003). Final results including intercontinental comparisons will be presented at the annual meeting of the ISHLT 2020. Results of this study may guide physicians and caregivers in better understanding gender specific differences and may improve overall outcomes.