Outcomes of elective versus emergent permanent mechanical circulatory support in the elderly: A single-center experience

Abstract

Advanced age is considered a relative contraindication to heart transplantation, but there is no published consensus on critical age in the case of mechanical circulatory support (MCS). This single-center study investigated outcomes of elective versus emergent implementation of permanent MCS in the elderly. Between January 1, 2006 and April 1, 2009, 31 patients, >65 years of age, were supported with a ventricular assist device (VAD), intended for permanent support, at our institution. The 28 left VAD (LVAD) recipients were divided into two groups: a survival group, n = 13 (ongoing MCS at 180 days or weaned); and a non-survival group, n = 15 (death on device within 180 days). In addition, the survival rate of LVAD recipients according to pre-operative INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) status was analyzed. The cumulative survival rates for the LVAD patients were 75% at 30 days, 46% at 180 days and 39% at 1 year after VAD implantation. The cumulative survival rates at 30 days, 180 days and 1 year were 71%, 47% and 35% for INTERMACS Level I to III (n = 17) patients vs 81%, 45% and 45% for INTERMACS Level IV to V (n = 11) patients (p = 0.9), respectively. Median age of LVAD recipients was 69 (range 66 to 80) years; 4 were women. Median support time was 565 (range 228 to 1,257) days. In 9 recipients support is ongoing. Both complications profiles and causes of death are reported. Our experience indicates that permanent MCS may be successful in highly selected elderly patients with terminal heart failure, especially when elective implantation is performed before development of inotropic dependency or cardiogenic shock. However, outcomes at 12 months in this selective elderly population remain uniformly poor.