title: Ventricular assist device implant in the elderly is associated with increased, but respectable risk: a multi-institutional study.
abstract: BACKGROUND
  There are an increasing number of elderly patients with end-stage heart failure. Destination mechanical circulatory support is often the only therapy available for these patients who are not transplant candidates. The outcomes after continuous flow left ventricular assist device (CF LVAD) implant in older patients remains unclear. We undertook this multi-institutional study to quantify short-term and midterm outcomes after CF LVAD implant in the elderly.
  
  
  METHODS
  We retrospectively analyzed all patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) national registry that underwent implant of a CF LVAD (June 2006 to April 2012). Patients were divided into 2 cohorts based upon age (<70 years [n = 4,439] and ≥ 70 years (n = 590]). Preoperative, intraoperative, and postoperative variables were analyzed. The primary endpoint, survival, was compared between cohorts.
  
  
  RESULTS
  Patients age 70 and older were more hemodynamically stable pre-VAD implant as evidenced by INTERMACS profile and inotrope dependence. Perioperative outcomes, including median bypass time (89 vs 89 minutes) and length of stay (0.657 vs 0.657 months) were similar between cohorts (p = not significant). Kaplan-Meier analysis revealed a significant difference in 2-year survival between patients aged 70 years or greater (63%) and less than 70 (71%, p < 0.001). Multivariable Cox proportional hazard analysis revealed age as an independent predictor of mortality during follow-up (p < 0.001). Nonetheless, midterm cumulative survival in the older cohort was still reasonable (63% at 2 years).
  
  
  CONCLUSIONS
  Multi-institutional analysis revealed advanced age as a predictor of increased mortality after CF LVAD implantation. Careful patient selection is critical in the elderly to optimize long-term outcomes after CF LVAD implantation.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
authors.forename: Pavan
authors.initials: P
authors.lastname: Atluri
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Goldstone
authors.forename: Dale M
authors.initials: DM
authors.lastname: Kobrin
authors.forename: Jeffrey E
authors.initials: JE
authors.lastname: Cohen
authors.forename: John W
authors.initials: JW
authors.lastname: MacArthur
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Howard
authors.forename: Mariell L
authors.initials: ML
authors.lastname: Jessup
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Rame
authors.forename: Michael A
authors.initials: MA
authors.lastname: Acker
authors.forename: Y Joseph
authors.initials: YJ
authors.lastname: Woo
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D016276:Ventricular Function; D055815:Young Adult