The Society of Thoracic Surgeons Intermacs 2025 Annual Report: Focus on Outcomes in Older Adults

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Overall cohort survival with fully magnetically levitated CF LVAD: 1-year 85.9%, 5-year 60.2%, 7-year 51.8%

• Primary Outcome: Survival in patients ≥65 years: 1-year 80.6%, 5-year 51.1%

• Nnt Or Sensitivity: Freedom from adverse events at 5 years: GI bleeding 73.5%, device malfunction 81.8%, stroke 87.1%

• Confidence Interval: Not reported in abstract

Clinical Application

Requires specialised cardiac surgery centres with LVAD programs; technology available in major Australian tertiary centres Relevant to Australian practice where LVADs are available through public system at major cardiac centres; outcomes may inform TGA device approvals and clinical guidelines for older adults Adults ≥65 years with advanced heart failure being considered for mechanical circulatory support, particularly those previously considered high-risk

Abstract

The 16th Annual Report from the Society of Thoracic Surgeons (STS) Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) includes 28,029 continuous-flow left ventricular assist devices (CF LVADs) implanted from 2015 to 2024. Survival remains excellent with the fully magnetically levitated CF LVAD (1-year survival: 85.9%, 5-year survival: 60.2%, 7-year survival: 51.8%). Patients also experience a low incidence of adverse events, including freedom from gastrointestinal bleeding (73.5%), device malfunction (81.8%), and stroke (87.1%) at 5 years, reinforcing the effectiveness of contemporary device platforms. However, despite these advancements, national durable LVAD implant volumes have remained stagnant. A focus on the subgroup of patients aged ≥65 years demonstrates excellent outcomes with respect to survival (1-year survival: 80.6%, 5-year survival: 51.1%), quality of life measures, and adverse events. Survival outcomes in this cohort are robust across a wide spectrum of clinical scenarios, including variation in acuity of illness, temporary mechanical circulatory support use, and psychosocial risk factors, historically associated with worse outcomes. Several clinical inferences may be drawn from these data. First, the increasingly elusive clinical equipoise between heart transplant listing vs a strategy of durable LVAD support merits an individualized and value-based approach to therapy in transplant-eligible older adults. Second, the prospect of 5-year survival exceeding 50%-even in septuagenarians-is a call to action to revise patient eligibility criteria, close the implementation gap, and realize the full potential of this life-saving therapy.

References

1. 1.Nayak, A., Cascino, T. M., DeFilippis, E. M., Hanff, T. C., Cevasco, M., Keenan, J., Zhen-Yu Tong, M., Kilic, A., Koehl, D., Cantor, R., Jacobs, J. P., Habib, R. H., Kirklin, J. K., Cowger, J. A., Pagani, F. D., & Silvestry, S. C. (2026). The Society of Thoracic Surgeons Intermacs 2025 Annual Report: Focus on Outcomes in Older Adults. *Annals of Thoracic Surgery*, *121*(1), 1-15. https://doi.org/10.1016/j.athoracsur.2025.10.005