Abstract 14896: Age is a Predictor of In-Hospital Mortality for Left Ventricular Assist Device: Implication in Post-2018 Donor Heart Allocation System

Abstract

Background: The introduction of the new heart allocation system in 2018 has significantly changed the landscape of heart transplantation and trends of durable left ventricular assist device (LVAD) utilization. Although the quality of durable LVAD has improved, the impact of age on in-hospital mortality for LVAD implantation remains unknown under the new allocation system. Objective: We aimed to investigate the influence of age on the outcome following the LVAD implantation under the new heart allocation system. Method: We utilized the National Inpatient Sample to investigate patients who underwent LVAD implantation between 2019 and 2020. The primary endpoint was in-hospital mortality following LVAD implantation, stratified by different age groups. We also investigated independent predictors of in-hospital mortality. Result: A total of 7,375 patients underwent LVAD implantation between January 2019 and December 2020. Among these patients, individuals aged 18-49, 50-59, 60-69, and over 70 years old accounted for 26%, 26%, 31%, and 17%, respectively. In-hospital mortality rates in the aforementioned age groups were 7%, 6%, 12%, and 17%, respectively. Notably, the age groups of 60-69 and over 70 compared to age <59 exhibited independent predictors of mortality, with an adjusted odds ratio (aOR) of 1.99 (p=0.02; 95% confidence interval [CI), 1.12-3.57) and 2.88 (p=0.002; 95% CI 1.45-5.71), respectively. Charlson Comorbidity Index (aOR, 1.39; p=0.02; 95% CI, 1.05-1.84) was also associated with increased risks of mortality. Conclusion: Our findings indicate that individuals over 60 years-old or with higher Charlson Comorbidity Index face a higher risk of in-hospital mortality following LVAD implantation.