Left Ventricular Assist Devices vs. Cardiac Transplantation: The Age Factor

Abstract

Background Outcomes of patients bridged with a left ventricular assist device (LVAD) when compared to primary cardiac transplantation may vary by age group. Methods Single-center study of patients who underwent cardiac transplantation or LVAD implantation. The study population was categorized by age groups. Group 1 included patients under 50 years of age, while Group 2 included patients over 50 years of age. For each age group, separate analyses of baseline demographics and outcomes were compared between 3 subgroups: patients bridged with an LVAD (BTT-LVAD group), primary cardiac transplantation patients (TXP group), and destination therapy (DT-LVAD group). For the BTT-LVAD group, survival was assessed from time of LVAD implantation and included days alive after cardiac transplantation. For the TXP group, survival was defined as days alive since transplantation. Kaplan-Meier curves were used to analyze survival between groups. Results A total of 380 patients were analyzed in the study. 136 patients were included in Group 1 (35.8%). At baseline, no significant differences with regards to age, gender, ethnicity and BMI were noted among subgroups. During the study period, 76% of Group 1 BTT-LVAD patients underwent transplantation. A high survival rate was observed with no significant differences in 1-year survival noted between subgroups (Group 1 BTT-LVAD: 96%; Group 1 TXP: 97.3%; Group 1 DT-LVAD:91.8%, p=0.472). 3-year survival remained high in Group 1 BTT-LVAD patients, but a significant decrease in survival of both Group 1 TXP and DT-LVAD was noted (Fig. A). Group 2 patients comprised 244 patients (64.2% of total population; Group 2 BTT-LVAD: 36.1.%; Group 2 TXP: 25.4%; Group 2 DT-LVAD: 38.5%). At baseline, no significant differences with regards to age, gender, BMI were noted among subgroups. Group 2 DT-LVAD had a higher proportion of black patients. During the study period, 76% of Group 2 BTT-LVAD patients underwent transplantation. A high survival rate was observed in Group 2 with no significant differences in 1-year survival noted between subgroups (Group 2 BTT-LVAD: 95.5%; Group 2 TXP: 87.1%; Group 2 DT-LVAD: 88.3%, p=0.14). 3-year survival remained high in Group 2 BTT-LVAD and TXP, but a significant decrease in survival of Group 2 DT-LVAD was noted (Fig. B). Conclusions Our study showed exceptionally high mid- and long-term survival rates in patients bridged with a LVAD in both age groups. While a TXP strategy may be reasonable in older patients, younger patients who underwent TXP had a significant decline in survival at 3 and 5 years. Conversely, outcomes of DT-LVAD therapy in younger patients continues to improve.