Outcomes of Heart Transplantation versus Left Ventricular Assist Device Implantation in Septuagenarians

Abstract

Purpose Prior studies have separately evaluated outcomes of heart transplantation (HT) and left ventricular assist device (LVAD) implantation in elderly versus younger patients. The optimal advanced therapy strategy in septuagenarians is not well-characterized. We performed a retrospective study to evaluate the outcomes of HT and LVAD in septuagenarians with advanced heart failure. Methods Septuagenarians who received advanced therapies at UC San Diego between 2011 and 2021 were reviewed. We assessed in-hospital morbidity and long-term survival between patients who underwent HT versus LVAD. For survival analysis, septuagenarians who were declined advanced therapies were used as comparison. Results Of 78 patients who underwent advanced therapies, 22 patients received HT and 56 patients received LVAD. The HT group was younger (71.1 vs 73.9 years, p < 0.001) and more had temporary mechanical circulatory support prior to surgery (68.2% vs 16.1%, p < 0.001). While the LVAD group experienced more post-operative right ventricular failure (13.6% vs 57.1%, p < 0.001) and arrhythmia (18.1% vs 46.4%, p = 0.02), length of stay was comparable (24.2 vs 37.1 days, p = 0.19). In mean follow up of 2.2 years, there was no difference in survival between HT and LVAD patients (77.3% vs 64.3%, log-rank p = 0.419). Both strategies offered a survival benefit compared to patients who were declined advanced therapies (Figure; log-rank p = 0.009). Conclusion In a single-center cohort, septuagenarians who underwent advanced therapies with HT and LVAD derived significant survival benefit at two years. Patients with LVAD experienced higher in-hospital morbidity compared to HT. Prior studies have separately evaluated outcomes of heart transplantation (HT) and left ventricular assist device (LVAD) implantation in elderly versus younger patients. The optimal advanced therapy strategy in septuagenarians is not well-characterized. We performed a retrospective study to evaluate the outcomes of HT and LVAD in septuagenarians with advanced heart failure. Septuagenarians who received advanced therapies at UC San Diego between 2011 and 2021 were reviewed. We assessed in-hospital morbidity and long-term survival between patients who underwent HT versus LVAD. For survival analysis, septuagenarians who were declined advanced therapies were used as comparison. Of 78 patients who underwent advanced therapies, 22 patients received HT and 56 patients received LVAD. The HT group was younger (71.1 vs 73.9 years, p < 0.001) and more had temporary mechanical circulatory support prior to surgery (68.2% vs 16.1%, p < 0.001). While the LVAD group experienced more post-operative right ventricular failure (13.6% vs 57.1%, p < 0.001) and arrhythmia (18.1% vs 46.4%, p = 0.02), length of stay was comparable (24.2 vs 37.1 days, p = 0.19). In mean follow up of 2.2 years, there was no difference in survival between HT and LVAD patients (77.3% vs 64.3%, log-rank p = 0.419). Both strategies offered a survival benefit compared to patients who were declined advanced therapies (Figure; log-rank p = 0.009). In a single-center cohort, septuagenarians who underwent advanced therapies with HT and LVAD derived significant survival benefit at two years. Patients with LVAD experienced higher in-hospital morbidity compared to HT.