Use of ventricular assist device as a bridge to cardiac transplantation: impact of age and other determinants on outcomes.
We sought to compare outcomes in patients > or = 60 years of age with those of their younger counterparts who underwent ventricular assist device implantation intended as a bridge to cardiac transplantation and also to identify retrospectively additional pre- and postoperative factors that might portend adverse outcomes.The medical records of 88 patients who were treated with bridge-to-transplantation ventricular assist devices from 1996 through 2007 were reviewed. Laboratory values, hemodynamic parameters, and the need for hemodynamic support were evaluated. Postoperative complications and bridge-to-transplantation success rates versus death rates were evaluated. Seventeen patients were > or = 60 years old and 71 patients were < 60 years old. In the older group, 59% of patients underwent successful bridging to transplantation, compared with 69% of the younger patients (P = 0.41). Multivariate analysis distinguished age > or = 60, female sex, earlier time period of operation, higher mean pulmonary arterial and central venous pressures, need for preoperative intra-aortic balloon pumps, and postoperative respiratory failure as independent risk factors for death. After orthotopic heart transplantation, survival to hospital discharge was 100% in the older group and 93.9% in the younger patients. Median lengths of stay were similar in both age categories.Multivariate analysis identified age as 1 of 6 independent risk factors for death in this study. Patients who successfully underwent cardiac transplantation, however, had similar survival statistics regardless of age category. Case-by-case evaluation is warranted when analyzing risk-benefit ratios of bridge-to-transplantation ventricular assist device therapy in the older patient population.
Kwon
Murray H
MH
Divisions of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095, USA. mkwon@mednet.ucla.edu
Moriguchi
Jaime D
JD
Ardehali
Abbas
A
Jocson
Rhodora
R
Marelli
Daniel
D
Laks
Hillel
H
Shemin
Richard J
RJ
Esmailian
Fardad
F
D000328:Adult; D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D002496:Central Venous Pressure; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D016016:Proportional Hazards Models; D011651:Pulmonary Artery / Q000503:physiopathology; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists