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Age and outcome after continuous-flow left ventricular assist device implantation as bridge to transplantation.
- Source :
-
The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation [J Heart Lung Transplant] 2009 Apr; Vol. 28 (4), pp. 367-72. - Publication Year :
- 2009
-
Abstract
- Objective: The effect of age on outcomes after continuous-flow left ventricular assist device (LVAD) implantation as a bridge to transplantation (BTT) was determined.<br />Methods: From November 1998 to July 2007, 86 patients with advanced heart failure underwent continuous-flow LVAD implantation as BTT and were retrospectively analyzed. Patients were categorized into 2 groups by age at LVAD implantation: 56 patients (65.1%) younger than 60, Group 1; and 30 (34.9%) aged 60 years or older, Group 2.<br />Results: Group 2 patients had a higher incidence of heart failure caused by ischemic heart disease (63.3% vs 32.1%, p = 0.005) and more severely impaired renal function by Modification of Diet in Renal Disease-derived glomerular filtration rates (51.9 +/- 15.9 vs. 68.0 +/- 20.5 ml/min/1.73 m(2), p < 0.001) than Group 1. Age was the only independent predictor of post-LVAD death (hazard ratio, 1.4 p = 0.003). The BTT rate was lower (33.3% vs 62.5%, p = 0.010), and incidence of post-LVAD renal failure was higher (53.3% vs 30.4%, p = 0.037) in Group 2 vs Group 1. Post-LVAD survival at 1, 3, and 6 months was 92.9%, 79.9%, and 74.0% for Group 1 and 90.0%, 62.0%, and 37.0% for Group 2 (p = 0.007). Post-transplant survival at 1, 3, and 5 years was 87.8%, 82.3%, and 76.0% for Group 1 and 90.0%, 67.5%, 67.5% for Group 2 (p = 0.517).<br />Conclusions: Patients aged 60 years and older have inferior post-LVAD survival; however, post-transplant survival is excellent. We advocate LVAD placement as bridge-to-transplant therapy only in carefully selected older patients most well suited for transplantation.
- Subjects :
- Adult
Age Factors
Aged
Female
Humans
Male
Middle Aged
Retrospective Studies
Survival Analysis
Survivors
Ventricular Dysfunction, Left complications
Ventricular Dysfunction, Left mortality
Heart Failure surgery
Heart Transplantation mortality
Heart Transplantation physiology
Heart-Assist Devices
Ventricular Dysfunction, Left surgery
Ventricular Dysfunction, Left therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1557-3117
- Volume :
- 28
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation
- Publication Type :
- Academic Journal
- Accession number :
- 19332264
- Full Text :
- https://doi.org/10.1016/j.healun.2009.01.008