title: Survival in elderly patients supported with continuous flow left ventricular assist device as bridge to transplantation or destination therapy.
abstract: BACKGROUND
  Published data on mechanical circulatory support for elderly patients in continuous flow devices are sparse and suggest relatively poor survival. This study investigated whether LVADs can be implanted in selected patients over the age of 65 years with acceptable survival compared with published outcomes.
  
  
  RESULTS
  A single-center retrospective analysis was conducted in 64 consecutive patients ≥65 years of age implanted with a continuous-flow left ventricular assist device (CF-LVAD) as either bridge to transplantation or destination therapy from August 2005 to January 2012. Baseline laboratory and hemodynamic characteristics and follow-up data were obtained. Median survival was 1,090 days. Survival was 85%, 74%, 55%, and 45% at 6 months and 1, 2, and 3 years, respectively. Our cohort had a baseline mean Seattle Heart Failure Model (SHFM) score of 2.6 ± 0.9. Observed survival was significantly better than SHFM-predicted medical survival. Stratification by age subsets, renal function, SHFM, implantation intention, or etiology did not reveal significant differences in survival. The most common cause of death was sepsis and nonlethalcomplication was bleeding.
  
  
  CONCLUSIONS
  Our experience with patients over the age of 65 receiving CF-LVADs suggests that this group demonstrates excellent survival. Further research is needed to discern the specific criteria for risk stratification for LVAD support in the elderly.
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Rosenbaum
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Liao
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Sirtaz
authors.initials: S
authors.lastname: Adatya
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Monica M
authors.initials: MM
authors.lastname: Colvin-Adams
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Marc
authors.initials: M
authors.lastname: Pritzker
authors.affiliation: Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota. Electronic address: eckmanp@umn.edu.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality* / Q000628:therapy*; D016027:Heart Transplantation / Q000401:mortality* / Q000639:trends*; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: LVAD; Survival; destination therapy; elderly