Should left ventricular assist devices be implanted in patients seventy years of age and older: a comparative...

We evaluated outcomes in left ventricular assist device (LVAD) recipients aged seventy years and above and compared results to outcomes in LVAD recipients below seventy years of age.

From March 2006 through June 2012, 130 patients underwent implantation of either a HeartMate II (HM II; Thoratec Corp., Pleasanton, CA) or HeartWare (HeartWare Inc., Framingham, MA) LVAD at our institution. Four patients underwent device exchanges and were excluded. Of the remaining 126 patients, 6 (4.7%) were ≥70 years of age. Patients in the age group ≥70 years were compared to the group of patients < 70 years for perioperative mortality, long-term survival and incidence of postoperative complications.

Mean age was 72.2 ± 2.3 (70-75) years for the older group and 52.8 ± 11.4 (18-69) years for the younger group (P < .001). There was no significant difference in the incidence of diabetes, hypertension, chronic renal insufficiency, dialysis, hepatic function, preoperative ventilation or previous cardiac surgery between the groups (P = NS). There was no significant difference in survival between the groups, with survival at 6 months, 1 year, and 2 years of 100%, 100% and 66.7% respectively for the older groups, versus 88.6%, 81.3% and 76.7% for the younger group (P = .634). There was no significant difference in postoperative bleeding requiring re-exploration, driveline infections, strokes, pneumonia, right ventricular failure, gastrointestinal bleeding or readmissions within thirty days (P = NS).

These data demonstrate similar short- and long-term results for the two groups of recipients of LVAD implantation. RESULTS support the use of long-term mechanical circulatory support in carefully selected elderly patients.