Age Is No Boundary to Long Term Survival on Permanent MCS: A Multicentre Experience

Abstract

Purpose Advanced age of patients (pts) is often considered to be a risk for morbidity and mortality in permanent Mechanical Circulatory Support (MCS). We investigated outcomes of aged vs younger pts implanted with Jarvik 2000 (intraventricular-axial-flow pump with novel power delivery system) and enrolled in the Italian Registry (IR) in terms of length of MCS out of hospital. Outcomes were also analyzed according to preoperative conditions and INTERMACS scale. Methods and Materials From June 2006 to September 2012, 79 consecutive end-stage heart failure adult pts (70 males, mean age 62 ±8 yrs, median 64 yrs, 52% ischemic cardiomyopathy, 95% ineligible for heart transplantation) were enrolled in the Jarvik 2000 IR. 36 pts were ≥65yr old (mean age 69 ±3 yrs, median 69 yrs, group A), 43 patients were 1 yr) and early deaths (subgroup A2, B2, on MCS Results 17/36 pts (subgroup A1) and 14/43 pts (subgroup B1) were on MCS > 1 year, all of them being discharged home. No significant difference in gender, etiology, pre-operative hemodynamics, pre-implant INTERMACS mean class (3.6 and 3.5 respectively) or mean time on MCS (699±241 and 865±311 days respectively) were found between the 2 groups. In 9 and 10 pts respectively MCS is ongoing. 5/36 pts (subgroup A2) and 9/43 pts (subgroup B2) were on MCS Conclusions In our experience, elderly patients on permanent MCS have comparable outcomes to their younger counterparts. For both groups we confirmed that results are optimal when elective LVAD implantation is performed before development of inotropic dependency or cardiogenic shock. These results suggest that age need not be a limiting factor in the decision to implant MCS in end stage heart failure.