Improved Outcomes in Left Ventricular Assist Device Therapy for Patients between 65 and 70 Years

Abstract

Purpose Left ventricular assist device therapy (LVAD) is effective management for advanced heart failure. INTERMACS data suggests increased early mortality in older recipients, but similar intermediate-term outcome among early survivors. We analyzed results of LVAD therapy in pt between 65 and 70 years and compared their outcomes with younger pt from our cohort. Methods and Materials Between 2004 and 2011, 295 pt Results Postop RV failure (OA: 4% vs. YA: 5%, p=1.00), dialysis (OA: 2% vs. YA: 9%; p=0.09), hospital LOS (p=0.68), and 90-day mortality (OA: 6% vs. YA: 8%; p=0.77) were similar. Median duration of support was 14 and 11 months for the OA and YA groups, respectively (p=0.27). Late pump-related intravascular hemolysis (p=0.33), driveline infection (p=0.78), and heart failure readmissions (p=0.23) were similar, while the OA group had more late neurological events (12% vs. 4%; p=0.04). Actuarial survival for the OA group was 81 +/- 12%, 72 +/- 14% and 66 +/- 17% at 12, 18 and 24 months, respectively. This was statistically similar to 85 +/- 5%, 82 +/- 6% and 76 +/- 8% survival at similar intervals for the YA cohort (p= 0.42). Conclusions Outcomes of LVAD therapy for pt between 65 and 70 years are similar to those of younger counterparts. While older pt have increased risk of late neurological events, late survival and other non-fatal morbidity are similar to younger pt. With demonstrated outcome improvement of LVAD therapy and paucity of donor organs for all pt, it is reasonable to revisit organ allocation strategies for older recipients.