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

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.