Faculty Collaboration Database

Impact of age on outcomes following continuous-flow left ventricular assist device implantation. Interact Cardiovasc Thorac Surg 2015 Jun;20(6):743-8

Date

03/15/2015

Pubmed ID

25770085

DOI

10.1093/icvts/ivv051

Scopus ID

2-s2.0-84930808528 (requires institutional sign-in at Scopus site)   16 Citations

Abstract

OBJECTIVES: The goal of our study was to analyse the impact of age on outcomes in patients who underwent continuous-flow left ventricular assist device (CF-LVAD) placement at our institution.

METHODS: One hundred and twenty-eight patients were implanted with a CF-LVAD between January 2008 and June 2014. Eighty-five patients were implanted with the device as a bridge to transplant (BTT); the remaining (n = 43) were on destination therapy (DT). Each group was divided into patients <65 years old and ≥ 65 years old at device implantation. Patients were followed up for at least 24 months or until transplant or death.

RESULTS: Eighty-five patients (66%) received a CF-LVAD as BTT. Patients ≥ 65 years old (n = 8) had a lower preoperative cardiac index and prothrombin time-international normalized ratio (P = 0.009), and a longer stay in the intensive care unit (P = 0.008). Adverse events including infections, re-exploration for bleeding, ischaemic and haemorrhagic stroke, renal failure and right heart failure were comparable in both age groups. Eighty-two percent (n = 63) of the young patients and 75% (n = 6) of the older patients, who were on LVAD as BTT, underwent heart transplant within the first 24 months of LVAD implantation. Overall survival at 3, 6, 12 and 24 months were 95, 95, 77 and 70%, respectively, post-CF-LVAD implantation as BTT for the younger group and 73% for the older group at 3, 6 and 12 months (P = 0.35). Forty-three patients (34%) received a CF-LVAD as DT. Patients ≥ 65 years old (n = 14) on DT had a higher incidence of peripheral vascular disease (P = 0.048), higher serum sodium (P = 0.004) and serum creatinine values (P = 0.002), preoperatively. There were more strokes in the older patients post-LAVD implantation (14 vs 0%; P = 0.048). Overall survival at 3, 6, 12 and 24 months were 85, 79, 75 and 62%, respectively, for the younger group and 93, 77, 67 and 34% for the older group, respectively (P = 0.26).

CONCLUSIONS: This study demonstrates that LVAD therapy can be used in the older patients with acceptable mortality and morbidity, and age alone should not be used as the sole criterion for exclusion from LVAD implantation.

Author List

Lushaj EB, Badami A, Osaki S, Murray M, Leverson G, Lozonschi L, Akhter S, Kohmoto T

Author

Takushi Kohmoto MD, PhD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Comorbidity
Disease Progression
Female
Heart Failure
Heart Transplantation
Heart-Assist Devices
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Patient Selection
Proportional Hazards Models
Prosthesis Design
Recovery of Function
Retrospective Studies
Risk Factors
Time Factors
Treatment Outcome
Ventricular Function, Left