ArticleThe Annals of thoracic surgery2026
Survival After Left Ventricular Assist Device: A Society of Thoracic Surgeons National Intermacs Database Risk Model Assessment.
Article in The Annals of thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSeveral left ventricular assist device (LVAD) risk models exist; however, currently, only 1 LVAD is available. Therefore, we assessed prognostic accuracy of including data from other durable LVADs vs fully magnetic devices only in 3-year survival models.
methodsAll patients receiving primary continuous flow LVADs in The Society of Thoracic Surgeons National Intermacs (Interagency Registry for Mechanically Assisted Circulatory Support) Database (January 2013-April 2023) were included. Patients were stratified into 3 cohorts: cohort 1, fully magnetic devices only, 2018-2023 (n = 12,449); cohort 2, hydrodynamic and magnetically levitated and axial flow devices, 2018-2023 (n = 3235); and cohort 3, hydrodynamic and magnetically levitated and axial flow devices, 2013-2017 (n = 14,019). Machine learning multivariable oblique random survival forests compared 3 models predicting 3-year survival in testing sets from the fully magnetic cohort. Model 1 included only cohort 1 patients; model 2 included cohorts 1 and 2; and model 3 included cohorts 1, 2, and 3.
resultsOf the patients with fully magnetic LVADs, 2552 (20.5%) died within 3 years of implantation. Model discrimination, assessed by mean time-dependent area under the curve, was similar for all 3 models (0.706, 0.700, and 0.706). Calibration evaluated by time-dependent delta Brier score demonstrated that model 1 had superior performance compared with model 2 (P = .016) and model 3 (P = .038), particularly after the first-year following implantation.
conclusionsModels including data from older/alternative durable LVADs showed similar or inferior performance compared with a model using fully magnetic device-only patients. These findings support current methodology including only patients receiving fully magnetic LVADs while also providing a framework for model comparisons in future device eras.
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