Elderly Patients with Higher Acuity Have Similar Left Ventricular Assist Device Outcomes As Younger Patients at a Nontransplant Center.
Journal of cardiac failure(2023)
摘要
Although left ventricular assist device (LVAD) implantation is associated with acceptable survival, previous reports have demonstrated that advanced age is associated with increased short-term mortality. Because age is a relative contraindication to transplantation, nontransplant centers tend to implant a disproportionate number of elderly patients. We undertook this study to evaluate the impact of advanced age on LVAD outcomes at a nontransplant center. We conducted a retrospective review of all LVAD implants at our center from 2017 to 2022. Primary stratification was by age > 70 years. The primary outcome was survival as assessed by the Kaplan- Meier method. The risk of 1-year mortality was further evaluated using multivariable Cox proportional hazards regression modeling. From 2017 to 2022, 93 patients underwent LVAD implantation. The mean age was 65.03 11.28 years, with a median age of 68 (60 to 73) years. Most patients were INTERMACS 1 or 2 (71 patients; 76.34%). When stratified by age, 41 patients (44.09%) were aged =70 years. Patients aged =70 years had similar 30-day (96.15% vs 100.00%, p = 0.213), 1year (90.05% vs 84.00%, p = 0.444), and 2-year survival (82.03% vs 84.00%, p = 0.870). When only the INTERMACS 1 and 2 patients with higher acuity were included, there was still no difference in 30-day, 1-year, or 2-year survival. On multivariable analysis, age >70 years was not associated with an increased hazard of 1-year mortality (0.90 [0.22 to 3.67], p = 0.878). In conclusion, in carefully selected patients, age >70 years is not associated with increased short-term mortality. Age alone should not be a contraindication to LVAD therapy. (c) 2022 Elsevier Inc. All rights reserved. (Am J Cardiol 2023;189:93-97)
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关键词
Left Ventricular Assist Device,Ventricular Assist Device,Advanced Life Support,Postinfarction Ventricular Septal Defect,Ventricular Reconstruction
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