Favorable Outcomes Using Long-Term Implantable Left Ventricular Assist Devices in Patients Sixty Five Years of Age and Older

Abstract

<h3>Purpose</h3> Advanced age is viewed by some programs as a relative contraindication for long-term mechanical circulatory support. The purpose of this study was to review our results with long-term left ventricular assist devices (LVADs) in patients 65 years or greater in age. <h3>Methods and Materials</h3> From March 2006 through June 2012, 130 patients underwent implantation of a HeartMate II or HeartWare LVAD at our institution. Four patients who underwent device exchanges were removed from the study. Of the remaining 126 patients, 24 (19.1%) were 65 years or greater. <h3>Results</h3> Mean age was 68.1 + 2.9 (65-75) years for the older group and 50.4 + 10.6 (18-64) years for the younger group (p<0.001). [figure 1] There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, or hepatic function between the groups (p=NS). A greater proportion of older patients had previous cardiac surgery (50.0% vs. 26.5%; p=0.047). There was no significant difference in survival between the groups with survival at 6 months, 1 year, and 2 years of 77.4%, 77.4%, 64.5%, respectively for the older groups versus 91.9%, 83.6%, 78.4% for the younger group (p=0.319). There was no significant difference in postoperative driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding, or readmissions within thirty days (p=NS). Using Cox Proportional Hazard Models, age ≥ 65 was not an independent predictor of mortality (p=NS). <h3>Conclusions</h3> These data demonstrate similar short and long-term results for elderly and young LVAD recipients. This supports proceeding with long-term mechanical circulatory support in carefully selected elderly patients.