title: Comparison of outcomes after heart replacement therapy in patients over 65 years old.
abstract: BACKGROUND
  There are currently no well-defined, evidence-based guidelines for management of end-stage heart failure in patients over 65, and the decisions to use mechanical circulatory support with left ventricular assist device (LVAD), either as a bridge to transplantation or destination therapy, or isolated heart transplantation (HTx) remain controversial. We aimed to compare the outcomes after the implementation of three heart replacement strategies in this high-risk population.
  
  
  METHODS
  We conducted a retrospective cohort study of all patients between the ages of 65 and 72 receiving a continuous-flow LVAD as bridge to transplantation or destination therapy or isolated HTx at our center between 2005 and 2012. The patients were stratified according to treatment strategy into three groups: group D (destination LVAD, n = 23), group B (bridge to transplantation LVAD, n = 43), and group H (HTx alone, n = 47). The primary outcomes of interest were survival to discharge and 2-year overall survival.
  
  
  RESULTS
  The patients in group D were significantly older, had a higher prevalence of ischemic cardiomyopathy, and had a higher pulmonary vascular resistance than did patients in groups B or H. There were no significant differences between groups in survival to discharge (87% D vs 83.7% B vs 87.2% H, p = 0.88) or 2-year overall survival (75.7% D vs 68.7% B vs 80.9% H, log-rank p = 0.47). The incidence rates of readmission were 1.1 events/patient·year in group D and 0.5 events/patient·year in group H.
  
  
  CONCLUSIONS
  There was no significant difference in perioperative, short-term, and medium-term survival between the treatment groups. However, the LVAD patients had a higher incidence of readmission. Larger trials are needed to refine differences in long-term survival, quality of life, and resource utilization for elderly patients requiring heart replacement therapy.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Halit
authors.initials: H
authors.lastname: Yerebakan
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Ryan
authors.initials: R
authors.lastname: Walters
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Paolo
authors.initials: P
authors.lastname: Colombo
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Melana
authors.initials: M
authors.lastname: Yuzefpolskaya
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Jorde
authors.affiliation: Division of Cardiology, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Donna
authors.initials: D
authors.lastname: Mancini
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York, New York. Electronic address: yn33@cumc.columbia.edu.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate