title: Age and outcome after continuous-flow left ventricular assist device implantation as bridge to transplantation.
abstract: OBJECTIVE
  The effect of age on outcomes after continuous-flow left ventricular assist device (LVAD) implantation as a bridge to transplantation (BTT) was determined.
  
  
  METHODS
  From November 1998 to July 2007, 86 patients with advanced heart failure underwent continuous-flow LVAD implantation as BTT and were retrospectively analyzed. Patients were categorized into 2 groups by age at LVAD implantation: 56 patients (65.1%) younger than 60, Group 1; and 30 (34.9%) aged 60 years or older, Group 2.
  
  
  RESULTS
  Group 2 patients had a higher incidence of heart failure caused by ischemic heart disease (63.3% vs 32.1%, p = 0.005) and more severely impaired renal function by Modification of Diet in Renal Disease-derived glomerular filtration rates (51.9 +/- 15.9 vs. 68.0 +/- 20.5 ml/min/1.73 m(2), p < 0.001) than Group 1. Age was the only independent predictor of post-LVAD death (hazard ratio, 1.4 p = 0.003). The BTT rate was lower (33.3% vs 62.5%, p = 0.010), and incidence of post-LVAD renal failure was higher (53.3% vs 30.4%, p = 0.037) in Group 2 vs Group 1. Post-LVAD survival at 1, 3, and 6 months was 92.9%, 79.9%, and 74.0% for Group 1 and 90.0%, 62.0%, and 37.0% for Group 2 (p = 0.007). Post-transplant survival at 1, 3, and 5 years was 87.8%, 82.3%, and 76.0% for Group 1 and 90.0%, 67.5%, 67.5% for Group 2 (p = 0.517).
  
  
  CONCLUSIONS
  Patients aged 60 years and older have inferior post-LVAD survival; however, post-transplant survival is excellent. We advocate LVAD placement as bridge-to-transplant therapy only in carefully selected older patients most well suited for transplantation.
authors.affiliation: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. sigrid.sandner@meduniwien.ac.at
authors.forename: Sigrid E
authors.initials: SE
authors.lastname: Sandner
authors.forename: Daniel
authors.initials: D
authors.lastname: Zimpfer
authors.forename: Philipp
authors.initials: P
authors.lastname: Zrunek
authors.forename: Angela
authors.initials: A
authors.lastname: Rajek
authors.forename: Heinrich
authors.initials: H
authors.lastname: Schima
authors.forename: Daniela
authors.initials: D
authors.lastname: Dunkler
authors.forename: Andreas O
authors.initials: AO
authors.lastname: Zuckermann
authors.forename: Georg M
authors.initials: GM
authors.lastname: Wieselthaler