Should Left Ventricular Assist Devices be Implanted in Patients Seventy Years of Age and Older: A Comparative Analysis
Background: We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age.
Methods: From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ?70 years of age. Patients in the age group ?70 years were compared to the group of patients < 70 years for perioperative mortality, long-term survival and incidence of postoperative complications.
Results: Mean age was 72.2 ± 2.3 (70-75) years for the older group and 52.8 ± 11.4 (18-69) years for the younger group (P < .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS).
Conclusions: These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. Results support the use of long-term mechanical circulatory support in carefully selected elderly patients.
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