Postcardiotomy mechanical circulatory support in the elderly

The role of mechanical circulatory support after cardiac operations in elderly patients is not clearly established. Between November 1985 and July 1989, 18 patients 65 years of age or older (mean age, 71 years; range, 65 to 82 years) were treated after cardiotomy with a centrifugal vortex or pneumatic mechanical ventricular assist device. This group comprised 1.9% of the 926 patients 65 years of age or older undergoing cardiac surgical procedures and 69% of the 26 patients requiring postcardiotomy support during this interval. Before institution of mechanical support, all patients were receiving maximal inotropic support and 16 patients had intraaortic balloon pumps inserted. Univentricular support was used in 9 patients (6 left, 3 right) and biventricular support in 9 patients. The mean duration of support was 45 hours (range, 8 to 118 hours). Twelve patients (67%) were successfully weaned, 8 (44%) were discharged from the hospital, and 6 (33%) remain alive 11 to 31 months postoperatively. Four of the 6 survivors are in New York Heart Association class I, 1 is in class II, and 1 is in class IV. The Combined Registry for ventricular assist device support has recently reported an overall survival rate of 12% in patients 65 to 70 years of age and 6% in those older than 70 years. Our results are comparable with those reported for younger patients and justify the use of postcardiotomy ventricular assist device support in the elderly.