Nationwide Outcomes and Predictors of Mortality After Left Ventricular Assist Device Implantation in Korea: Insights From the Korean Registry for Mechanically Assisted Circulatory Support.

Background: Durable left ventricular assist device (LVAD) therapy was introduced in Korea in 2018 within a transplant environment characterized by frequent preoperative extracorporeal membrane oxygenation (ECMO) support. We evaluated nationwide outcomes and predictors of mortality after LVAD implantation. Methods and Results: This registry-based cohort study included all durable LVAD implantations performed in Korea between September 2018 and December 2023 using the Korean Mechanically Assisted Circulatory Support registry. The primary outcome was all-cause mortality. Survival was assessed with Kaplan-Meier and competing risk analyses, and predictors were identified using multivariable Cox models. Among 465 patients (median age 62 years; 78% male), 367 underwent bridge-to-transplantation (BTT) and 98 destination therapy (DT). Preoperative ECMO was used in 27.5%. One-year survival was 83.1% overall and higher in BTT than DT (87.4% vs. 69.6%; P<0.001). At 1 year, 59.6% remained on LVAD support, 24.8% underwent transplantation, and 15.6% died. Arrhythmia, bleeding, and infection were the most common complications. In multivariable analysis, age 60-69 years (hazard ratio [HR] 3.80; 95% confidence interval [CI] 1.73-8.31) and preoperative ECMO (HR 2.85; 95% CI 1.76-4.60) independently predicted mortality, whereas treatment strategy did not. Conclusions: In this high-acuity population with frequent preoperative ECMO support, nationwide LVAD outcomes were comparable to international benchmarks. Mortality was more closely associated with preoperative clinical status than with treatment strategy.