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

 

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Objectives: 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 long-term outcome among patients undergoing MCS therapy and that these outcomes differ between continents.

Methods: 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 17,329 patients. For each computation, only cases without missing values on the variables involved in that particular analysis were analyzed. Gender-specific survival curves will be drawn using the Kaplan–Meier method and using the log-rank test to test the equality of the survival curves.

Results: We included 17,329 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 were 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 were no significant differences regarding need of temporary right ventricular support (2.6% female vs. 2% male; p = 0.0483) whereas 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 bleeding events in general but women showed more intra-abdominal and urinary tract associated bleeding complications (2.8% female vs. 2.4% male; p = 0.0245). The rate of pump thrombosis was significantly higher in the male patient group with 1.3 versus 0.8% among female patients (p = 0.0029). Final results including intercontinental comparisons will be presented at the annual meeting of the GSTCVS 2019.

Conclusion: In this large study, focusing on gender and intercontinental differences, we found significant differences in pre-, peri- and long-term results between male and female LVAD recipients. These results may guide physicians and caregivers in better understanding gender specific differences and, therefore, may improve overall outcomes.