title: Posttransplant Outcomes Among Septuagenarians Bridged to Transplantation With Continuous-Flow Left Ventricular Assist Devices.
abstract: BACKGROUND
  A bridge to transplant strategy with a continuous-flow left ventricular assist device is increasingly being offered to older patients. However, the upper patient age limit has not been defined.
  
  
  METHODS
  The United Network of Organ Sharing (UNOS) database was used to identify 21,258 heart transplant recipients from 2004 to 2014. Of these, 4,850 (22.8%) were bridged with a continuous-flow left ventricular assist device. Recipients were stratified by age: group 1, aged 70 years or more (n = 115, 2.4%); and group 2, aged 18 to 69 years (n = 4,735, 97.6%).
  
  
  RESULTS
  Elderly patients more likely had ischemic etiology than younger patients (69.6% versus 41.0%; p < 0.001), and received a heart from an older donor (35.8 versus 31.3 years, p < 0.001) or an expanded criteria donor (8.7% versus 2.4%; p < 0.001). Elderly patients had decreased 90-day survival (88.8% versus 93.2%; p = 0.021) and 3-year posttransplant survival (80.9% versus 85.7%; p = 0.073). However, analysis of a propensity matched cohort did not demonstrate survival difference at 90 days and 3 years. Among septuagenarians, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was a predictor for 90-day mortality (hazard ratio 4.48, 95% confidence interval: 1.90 to 10.55; p = 0.001) and 3-year mortality (hazard ratio 2.27, 95% confidence interval: 1.51 to 3.41; p < 0.001), whereas functional independence was protective for 3-year mortality (hazard ratio 0.11, 95% confidence interval: 0.013 to 0.86; p = 0.036). Functionally independent patients showed a remarkably superior posttransplant survival compared with functionally dependent patients (96.7% versus 42.8% at 3 years; p = 0.001).
  
  
  CONCLUSIONS
  The continuous-flow left ventricular assist device supported septuagenarians did not have increased posttransplant mortality. Functional outcomes during device support may have important implications for organ allocation among the elderly.
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors: Shinichi
authors: S
authors: Fukuhara
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors: Koji
authors: K
authors: Takeda
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors: Alexander
authors: A
authors: Blair
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors: Paul A
authors: PA
authors: Kurlansky
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York.
authors: Hiroo
authors: H
authors: Takayama
authors: Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, New York. Electronic address: yn33@cumc.columbia.edu.
authors: Yoshifumi
authors: Y
authors: Naka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult