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Ondrusek M, Artemiou P, Bezak B, Gasparovic I, By TMD, Durdik S, Lesny P, Goncalvesova E, Hulman M. Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study. Thorac Cardiovasc Surg 2024. [PMID: 38641334 DOI: 10.1055/s-0044-1782600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. METHODS The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007-2015; period 2: 2016-20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. RESULTS Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. CONCLUSION Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.
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Affiliation(s)
- Matej Ondrusek
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Branislav Bezak
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Theo Mmh de By
- EUROMACS, European Association for Cardio-Thoracic Surgery (EACTS), Windsor, United Kingdom
| | - Stefan Durdik
- Faculty of Medicine, Comenius University, St. Elizabeth Oncology Institute, Clinic of Surgical Oncology, Bratislava, Slovakia
| | - Peter Lesny
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
| | - Eva Goncalvesova
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
| | - Michal Hulman
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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2
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Jawaid O, Salerno C, Ravichandran A. Left Ventricular Assist Device and the Current State of the Art: HeartMate 3 at 5 Years. Heart Fail Clin 2024; 20:83-89. [PMID: 37953024 DOI: 10.1016/j.hfc.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Left ventricular assist devices (LVADs) or cardiac transplantation are the two prevailing methods of treating patients with end-stage heart failure. The availability of donor hearts is insufficient to meet the needs of patients with advanced heart failure. LVADs offer a potential alternative to transplantation for those patients who cannot wait or are otherwise unsuited for cardiac transplantation. The field has made tremendous progress in the past 20 years. In this review, the current state of the art is summarized with respect to current generation LVADs.
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Affiliation(s)
- Omar Jawaid
- St. Vincents' Ascension, 8333 Naab Road, Indianapolis, IN 46260, USA
| | - Christopher Salerno
- University of Chicago Medical Center, 5841 South Maryland Avenue, Chicago, IL 60637, USA
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3
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Taj J, Taylor EP. End-Stage/Advanced Heart Failure: Geriatric Palliative Care Considerations. Clin Geriatr Med 2023; 39:369-378. [PMID: 37385689 DOI: 10.1016/j.cger.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Heart failure remains a condition with high morbidity and mortality affecting 23 million people globally with a cost burden equivalent to 5.4% of the total health care budget in the United States. These costs include repeated hospitalizations as the disease advances and care that may not align with individual wishes and values. The coincidence of comorbid conditions with advanced heart failure poses significant challenges in the geriatric population. Advance care planning, medication education, and minimizing polypharmacy are primary palliative opportunities leading to specialist palliative care such as symptom management at end of life and timing of referral to hospice.
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Affiliation(s)
- Jabeen Taj
- Division of Hospice and Palliative Medicine, Department of Family Medicine, Emory University School of Medicine, Emory University Hospital, 1364 Clifton Road, Atlanta, GA 30322, USA.
| | - Emily Pinto Taylor
- Division of General Internal Medicine, Department of Family Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA; Division of Hospice and Palliative Medicine, Department of Family Medicine, Emory University School of Medicine, Grady Memorial Hospital, 80 Jesse Hill Drive Southeast, Atlanta, GA 30303, USA
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4
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Siems C, Aggarwal R, Shaffer A, John R. Right heart failure after left ventricular assist device implantation: a persistent problem. Indian J Thorac Cardiovasc Surg 2023; 39:161-169. [PMID: 37525713 PMCID: PMC10387018 DOI: 10.1007/s12055-023-01481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/09/2022] [Accepted: 01/17/2023] [Indexed: 02/24/2023] Open
Abstract
Left ventricular assist device (LVAD) is an option for bridge-to-transplant or destination therapy for patients with end-stage heart failure. Right heart failure (RHF) remains a complication after LVAD implantation that portends high morbidity and mortality, despite advances in LVAD technology. Definitions of RHF vary, but generally include the need for inotropic or pulmonary vasodilator support, or potential right ventricular (RV) mechanical circulatory support. This review covers the complex pathophysiology of RHF related to underlying myocardial dysfunction, interventricular dependence, and RV afterload, as well as treatment strategies to curtail this challenging problem.
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Affiliation(s)
- Chesney Siems
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Rishav Aggarwal
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Andrew Shaffer
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
| | - Ranjit John
- Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, 420 Delaware Street SE, MMC 207, Minneapolis, MN 55455 USA
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5
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Cordero-Cabán K, Ssembajjwe B, Patel J, Abramov D. How to select a patient for LVAD. Indian J Thorac Cardiovasc Surg 2023; 39:8-17. [PMID: 37525705 PMCID: PMC10386996 DOI: 10.1007/s12055-022-01428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/19/2022] [Accepted: 10/10/2022] [Indexed: 12/16/2022] Open
Abstract
Left ventricular assist device (LVAD) implantation leads to improvement in symptoms and survival in patients with advanced heart failure. An important factor in improving outcomes post-LVAD implantation is optimal preoperative patient selection and optimization. In this review, we highlight the latest on the evaluation of patients with advanced heart failure for LVAD candidacy, including discussion of patient selection, implantation timing, laboratory and other testing considerations, and the importance of psychosocial evaluation. Such thorough evaluation by multidisciplinary team can serve to improve the outcomes of a complex group of patients with advanced heart failure being evaluated for LVAD.
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Affiliation(s)
- Kathia Cordero-Cabán
- Internal Medicine Department, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354 USA
| | - Brian Ssembajjwe
- Internal Medicine Department, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354 USA
| | - Jay Patel
- Division of Cardiology, Loma Linda Veterans Administration Healthcare System, Loma Linda, CA USA
| | - Dmitry Abramov
- Cardiology Department, Loma Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354 USA
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6
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Radhoe SP, Veenis JF, Jakus N, Timmermans P, Pouleur A, Rubís P, Van Craenenbroeck EM, Gaizauskas E, Barge‐Caballero E, Paolillo S, Grundmann S, D'Amario D, Braun OÖ, Gkouziouta A, Planinc I, Samardzic J, Meyns B, Droogne W, Wierzbicki K, Holcman K, Flammer AJ, Gasparovic H, Biocina B, Lund LH, Milicic D, Ruschitzka F, Cikes M, Brugts JJ. How does age affect outcomes after left ventricular assist device implantation: results from the PCHF‐VAD registry. ESC Heart Fail 2022; 10:884-894. [PMID: 36460627 PMCID: PMC10053271 DOI: 10.1002/ehf2.14247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/05/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
AIMS Use of left ventricular assist devices (LVADs) in older patients has increased, and assessing outcomes in older LVAD recipients is important. Therefore, this study aimed to investigate associations between age and outcomes after continuous-flow LVAD (cf-LVAD) implantation. METHODS AND RESULTS Cf-LVAD patients from the multicentre European PCHF-VAD registry were included and categorized into those <50, 50-64, and ≥65 years old. The primary endpoint was all-cause mortality. Among secondary outcomes were heart failure (HF) hospitalizations, right ventricular (RV) failure, haemocompatibility score, bleeding events, non-fatal thromboembolic events, and device-related infections. Of 562 patients, 184 (32.7%) were <50, 305 (54.3%) were aged 50-64, whereas 73 (13.0%) were ≥65 years old. Median follow-up was 1.1 years. Patients in the oldest age group were significantly more often designated as destination therapy (DT) candidates (61%). A 10 year increase in age was associated with a significantly higher risk of mortality (hazard ratio [HR] 1.34, 95% confidence interval [CI] [1.15-1.57]), intracranial bleeding (HR 1.49, 95% CI [1.10-2.02]), and non-intracranial bleeding (HR 1.30, 95% CI [1.09-1.56]), which was confirmed by a higher mean haemocompatibility score (1.37 vs. 0.77, oldest vs. youngest groups, respectively, P = 0.033). Older patients suffered from less device-related infections requiring systemic antibiotics. No age-related differences were observed in HF-related hospitalizations, ventricular arrhythmias, pump thrombosis, non-fatal thromboembolic events, or RV failure. CONCLUSIONS In the PCHF-VAD registry, higher age was associated with increased risk of mortality, and especially with increased risk of major bleeding, which is particularly relevant for the DT population. The risks of HF hospitalizations, pump thrombosis, ventricular arrhythmia, or RV failure were comparable. Strikingly, older patients had less device-related infections.
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Affiliation(s)
- Sumant P. Radhoe
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Jesse F. Veenis
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nina Jakus
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | | | - Anne‐Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases Cliniques Universitaires St. Luc Brussels Belgium
- Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC) Université Catholique de Louvain Louvain Belgium
| | - Pawel Rubís
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Edvinas Gaizauskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine Vilnius University Vilnius Lithuania
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences Federico II University of Naples Naples Italy
| | - Sebastian Grundmann
- Faculty of Medicine, Heart Center Freiburg University University of Freiburg Freiburg Germany
| | - Domenico D'Amario
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Oscar Ö. Braun
- Department of Cardiology, Clinical Sciences Lund University and Skåne University Hospital Lund Sweden
| | | | - Ivo Planinc
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jure Samardzic
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bart Meyns
- Department of Cardiac Surgery University Hospital Leuven Leuven Belgium
| | - Walter Droogne
- Department of Cardiology University Hospital Leuven Leuven Belgium
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | - Katarzyna Holcman
- Department of Cardiac and Vascular Diseases Krakow Jagiellonian University Medical College, John Paul II Hospital Krakow Poland
| | | | - Hrvoje Gasparovic
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Bojan Biocina
- Department of Cardiac Surgery University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Lars H. Lund
- Department of Medicine Karolinska Institute Stockholm Sweden
| | - Davor Milicic
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Frank Ruschitzka
- Clinic for Cardiology University Hospital Zurich Zurich Switzerland
| | - Maja Cikes
- Department of Cardiovascular Diseases University of Zagreb School of Medicine and University Hospital Center Zagreb Zagreb Croatia
| | - Jasper J. Brugts
- Department of Cardiology Thorax Center, Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
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7
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Yoshimura A, Kikuchi N, Saito S, Suzuki A, Hattori H, Shoda M, Ichihara Y, Niinami H, Hagiwara N, Yamaguchi J, Nunoda S. Stratification of Destination Therapy Candidates by J-HeartMate Risk Score Among Elderly Non-Responders to Cardiac Resynchronization Therapy. Circ Rep 2022; 4:405-411. [PMID: 36120479 PMCID: PMC9437474 DOI: 10.1253/circrep.cr-22-0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 11/09/2022] Open
Abstract
Background: For elderly patients with refractory heart failure (HF), destination therapy (DT) with a continuous-flow left ventricular assist device (LVAD) is a possible treatment. The aim of DT is for long-term, satisfying quality of life on LVAD support. Previously, elderly non-responders to cardiac resynchronization therapy (CRT) were primarily destined for palliative care, but DT has been available in Japan since April 30, 2021. This study investigated the prognosis of elderly CRT non-responders and assessed the feasibility of DT in these patients based on the J-HeartMate Risk Score (J-HMRS). Methods and Results: Of the 559 patients who underwent CRT at Tokyo Women’s Medical University between 2000 and 2018, 198 were aged 65–75 years. Among these, 76 were identified as non-responders based on echocardiographic data, and were included in this study. We calculated patients’ J-HMRS and investigated associations between the J-HMRS and cardiac events after CRT. Patients were divided into 3 groups according to the J-HMRS: low (n=23), medium (n=29), and high (n=24) risk. Patients in the low-risk group experienced as many HF rehospitalizations and ventricular arrhythmia events as those in the other groups. However, survival analysis revealed that, after CRT, survival was higher for patients in the low- compared with high-risk group (P=0.04). Conclusions: The J-HMRS classified 30% of elderly CRT non-responders as low risk and as suitable candidates for DT in Japan.
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Affiliation(s)
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women’s Medical University
| | - Satoshi Saito
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Atsushi Suzuki
- Department of Cardiology, Tokyo Women’s Medical University
| | | | - Morio Shoda
- Department of Cardiology, Tokyo Women’s Medical University
| | - Yuki Ichihara
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | | | | | - Shinichi Nunoda
- Therapeutic Strategy for Severe Heart Failure, Tokyo Women’s Medical University Graduate School of Medicine
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8
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Roth S, M'Pembele R, Stroda A, Voit J, Lurati Buse G, Sixt SU, Westenfeld R, Polzin A, Rellecke P, Tudorache I, Hollmann MW, Boeken U, Akhyari P, Lichtenberg A, Huhn R, Aubin H. Days alive and out of hospital after left ventricular assist device implantation. ESC Heart Fail 2022; 9:2455-2463. [PMID: 35513994 PMCID: PMC9288752 DOI: 10.1002/ehf2.13942] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 11/05/2022] Open
Abstract
Aims Implantation of left ventricular assist devices (LVADs) as a bridge to transplant or as destination therapy is increasing. The selection of suitable patients and outcome assessment belong to the key challenges. Mortality has traditionally been a focus of research in this field, but literature on quality of life is very limited. This study aimed to identify perioperative factors influencing patients' life as measured by days alive and out of hospital (DAOH) in the first year after LVAD implantation. Methods and results This retrospective single‐centre cohort study screened 227 patients who underwent LVAD implantation at the University Hospital Duesseldorf, Germany, between 2010 and 2020. First, the influence of 10 prespecified variables on DAOH was investigated by univariate analysis. Second, multivariate quantile regression was conducted including all factors with significant influence on DAOH in the univariate model. Additionally, the impact of all variables on 1 year mortality was investigated using Kaplan–Meier curves to oppose DAOH and mortality. In total, 221 patients were included into analysis. As pre‐operative factors, chronic kidney disease (CKD), pre‐operative mechanical circulatory support (pMCS), and Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) stadium < 3 were associated with lower DAOH at 1 year [CKD: 280 (155–322) vs. 230 (0–219), P = 0.0286; pMCS: 294 (155–325) vs. 243 (0–293), P = 0.0004; INTERMACS 1: 218 (0–293) vs. INTERMACS 2: 264 (6–320) vs. INTERMACS 3: 299 (228–325) vs. INTERMACS 4: 313 (247–332), P ≤ 0.0001]. Intra‐operative additional implantation of a right ventricular assist device (RVAD) was also associated with lower DAOH [RVAD: 290 (160–325) vs. 174 (0–277), P ≤ 0.0001]. As post‐operative values that were associated with lower DAOH, dialysis and tracheotomy could be identified [dialysis: 300 (252–326) vs. 186 (0–300), P ≤ 0.0001; tracheotomy: 292 (139–325) vs. 168 (0–269), P ≤ 0.0001]. Multivariate analysis revealed that all of these factors besides pMCS were independently associated with DAOH. According to Kaplan–Meier analysis, only post‐operative dialysis was significantly associated with increased mortality at 1 year (survival: no dialysis 89.4% vs. dialysis 70.1%, hazard ratio: 0.56, 95% confidence interval: 0.33–0.94; P = 0.031). Conclusions The results of this study indicate that there can be a clear discrepancy between hard endpoints such as mortality and more patient‐centred outcomes reflecting life impact. DAOH may relevantly contribute to a more comprehensive selection process and outcome assessment in LVAD patients.
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Affiliation(s)
- Sebastian Roth
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - René M'Pembele
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Alexandra Stroda
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Josephine Voit
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Giovanna Lurati Buse
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Stephan U Sixt
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Ralf Westenfeld
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Amin Polzin
- Department of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Philipp Rellecke
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Markus W Hollmann
- Department of Anesthesiology, Amsterdam University Medical Center (AUMC), Location AMC, Amsterdam, The Netherlands
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.,Department of Anesthesiology, Kerckhoff Heart and Lung Center, Bad Nauheim, Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Duesseldorf, Moorenstr. 5, Duesseldorf, 40225, Germany
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9
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Bourque K, Fraser CE, Lorts A, Molina EJ, Kormos RL, Naka Y, Sheikh FH, Uriel NY, Morales DLS. Special Considerations for Durable Left Ventricular Assist Device Use in Small Patients. ASAIO J 2022; 68:619-622. [PMID: 35275881 DOI: 10.1097/mat.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Angela Lorts
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ezequiel J Molina
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | | | - Yoshifumi Naka
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
| | - Farooq H Sheikh
- MedStar Washington Hospital Center/Georgetown University, Washington, DC
| | - Nir Y Uriel
- Weill Cornell Medical College/New York Presbyterian Hospital, New York, New York
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10
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Liu E, Lampert BC. Heart Failure in Older Adults: Medical Management and Advanced Therapies. Geriatrics (Basel) 2022; 7:geriatrics7020036. [PMID: 35447839 PMCID: PMC9029870 DOI: 10.3390/geriatrics7020036] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/10/2022] [Accepted: 03/15/2022] [Indexed: 12/04/2022] Open
Abstract
As the population ages and the prevalence of heart failure increases, cardiologists and geriatricians can expect to see more elderly patients with heart failure in their everyday practice. With the advancement of medical care and technology, the options for heart failure management have expanded, though current guidelines are based on studies of younger populations, and the evidence in older populations is not as robust. Pharmacologic therapy remains the cornerstone of heart failure management and has improved long-term mortality. Prevention of sudden cardiac death with implantable devices is being more readily utilized in older patients. Advanced therapies have provided more options for end-stage heart failure, though its use is still limited in older patients. In this review, we discuss the current guidelines for medical management of heart failure in older adults, as well as the expanding literature on advanced therapies, such as heart transplantation in older patients with end-stage heart failure. We also discuss the importance of a multidisciplinary care approach including consideration of non-medical co-morbidities such as frailty and cognitive decline.
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11
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Heart Transplant in Older Adults. CURRENT TRANSPLANTATION REPORTS 2022; 9:48-54. [PMID: 35039790 PMCID: PMC8755401 DOI: 10.1007/s40472-022-00358-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/22/2022]
Abstract
Purpose of Review Older adults with end-stage heart failure may be candidates for heart transplantation (HT) and changing guidelines and institutional policies have increased the availability of HT for septuagenarians. This review explores historical, pre-HT evaluation, and post-HT outcomes for older adult HT recipients. Recent Findings Rates of HT in older adults have increased in the past decade and more than 800 septuagenarians have undergone HT. Older adult HT recipients have similar survival, rehospitalization, and graft failure rates when compared to younger patients despite additional comorbidities and higher risk donors. Summary HT is feasible in carefully selected older adults. As the number of older adults who are considered for HT increases, additional research into population-specific assessment tools will be needed. Furthermore, age-related immune changes warrant population-specific studies on immunosuppressive regimens.
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12
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Roehrich L, Sündermann SH, Just IA, Kopp Fernandes L, Stein J, Solowjowa N, Mulzer J, Mueller M, Hummel M, Knierim J, Potapov E, Falk V, Schoenrath F. Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation. ESC Heart Fail 2022; 9:1038-1049. [PMID: 34994094 PMCID: PMC8934953 DOI: 10.1002/ehf2.13764] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 11/07/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022] Open
Abstract
AIMS Assessing frailty and sarcopenia is considered a valuable cornerstone of perioperative risk stratification in advanced heart failure patients. The lack of an international consensus on a diagnostic standard impedes its implementation in the clinical routine. This study aimed to compare the feasibility and prognostic impact of different assessment tools in patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. METHODS AND RESULTS We prospectively compared feasibility and prognostic values of six frailty/sarcopenia assessment methods in 94 patients prior to cf-LVAD implantation: bioelectrical impedance analysis (BIA), computed tomography (CT)-based measurement of two muscle areas/body surface area [erector spinae muscle (TMESA/BSA) and iliopsoas muscle (TPA/BSA)], physical performance tests [grip strength, 6 min walk test (6MWT)] and Rockwood Clinical Frailty Scale (RCFS). Six-month mortality and/or prolonged ventilation time >95 h was defined as the primary endpoint. BIA and CT showed full feasibility (100%); physical performance and RCFS was limited due to patients' clinical status (feasibility: 87% grip strength, 62% 6MWT, 88% RCFS). Phase angle derived by BIA showed the best results regarding the prognostic value for 6 month mortality and/or prolonged ventilation time >95 h (odds ratio (OR) 0.66 [95% confidence interval (CI): 0.46-0.92], P = 0.019; area under the curve (AUC) 0.65). It provided incremental value to the clinical risk assessment of EuroSCORE II: C-index of the combined model was 0.75 [95% CI; 0.651-0.848] compared with C-index of EuroSCORE II alone, which was 0.73 (95% CI: 0.633-0.835). Six-month survival was decreased in patients with reduced body cell mass derived by BIA or reduced muscle area in the CT scan compared with patients with normal values: body cell mass 65% (95% CI: 51.8-81.6%) vs. 83% (95% CI: 74.0-93.9%); P = 0.03, TMESA/BSA 65% (95% CI: 51.2-82.2%) vs. 82% (95% CI: 73.2-93.0%); P = 0.032 and TPA/BSA 66% (95% CI: 53.7-81.0%) vs. 85% (95% CI: 75.0-95.8%); P = 0.035. CONCLUSIONS Bioelectrical impedance analysis parameters and CT measurements were shown to be suitable to predict 6-month mortality and/or prolonged ventilation time >95 h in patients with advanced heart failure prior to cf-LVAD implantation. Phase angle had the best predictive capacity and sarcopenia diagnosed by reduced body cell mass in BIA or muscle area in CT was associated with a decreased 6 month survival.
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Affiliation(s)
- Luise Roehrich
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,German Heart Foundation, Frankfurt am Main, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Isabell Anna Just
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Laurenz Kopp Fernandes
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Julia Stein
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Natalia Solowjowa
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Johanna Mulzer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Marcus Mueller
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | | | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Evgenij Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiovascular Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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13
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Jaiswal A, Gadela NV, Baran D, Balakumaran K, Scatola A, Radojevic J, Gluck J, Arora S, Hammond J, Ali A, Jennings DL, Baker WL. Clinical outcomes of older adults listed for heart transplantation in the United States. J Am Geriatr Soc 2021; 69:2507-2517. [PMID: 34105139 DOI: 10.1111/jgs.17271] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To examine if older age (>70 years) should be a relative contraindication for heart transplantation, we evaluated the characteristics and outcomes of patients with age ≥70 years listed for heart transplantation; and whether post-transplantation survival was inferior to younger counterparts. DESIGN Retrospective cohort analysis. SETTING The scientific registry of transplant recipients (SRTR). PARTICIPANTS Adults (≥18 years) listed for heart transplantation in the SRTR between 2000 and 2018. INTERVENTIONS Heart transplantation. MEASUREMENTS Characteristics and outcomes were compared for adults ≥70 years and <70 years. We evaluated waitlist mortality and post-transplant 1-year and 5-year survivals. RESULTS The study included 57,285 patients (age range 18-79 years) listed for heart transplantation; 1203 (2.1%) age ≥70 years. Of these, 37,135 patients underwent heart transplantation; 806 (2.2%) were age ≥70 years. Yearly listing of those age ≥70 years has consistently increased from 2.5% (n = 30) in 2000 to 11% (n = 132) in 2017 (p < 0.01). As compared with the age <70 years group, those ≥70 years had a similar risk of death while waiting (sub-hazard ratio [SHR] 0.86, 95% confidence interval [HR] 0.68-1.08; p = 0.19) but were more likely to be transplanted (SHR 1.36, 95% CI 1.26-1.48; p < 0.01). Among the older patients, the overall post-transplant 1- and 5-year mortality rate was 10.4% and 19.2%, respectively. Older recipients had lower unadjusted survival compared with younger recipients (log-rank p = 0.03). However, after adjustment for relevant covariates, there was no significant difference in 5-year mortality between both groups (HR 1.06, 95% CI 0.91-1.254; p = 0.43). CONCLUSIONS Post-transplant survival up to 5 years among patients of age ≥70 years was similar to that of younger recipients. Older patients who received heart transplantation appear to have lower risk features but receive hearts from higher risk donors. Chronologic age alone should not constitute a contraindication for heart transplantation, although careful patient selection criteria should be applied.
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Affiliation(s)
- Abhishek Jaiswal
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Naga Vaishnavi Gadela
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - David Baran
- Sentara Heart Hospital, Advanced Heart Failure Center, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Kathir Balakumaran
- Heart and Vascular Center, Metrohealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Andrew Scatola
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Joseph Radojevic
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Jason Gluck
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Sabeena Arora
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Jonathan Hammond
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Ayyaz Ali
- Hartford Healthcare Heart and Vascular Institute, Hartford Hospital, Hartford, Connecticut, USA
| | - Douglas L Jennings
- Department of Pharmacy Practice, Long Island University, New York, New York, USA.,New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA
| | - William L Baker
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, Connecticut, USA
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14
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Pavol MA, Boehme AK, Yuzefpolskaya M, Maurer MS, Casida J, Festa JR, Ibeh C, Willey JZ. Cognition predicts days-alive-out-of-hospital after LVAD implantation. Int J Artif Organs 2021; 44:952-955. [PMID: 34011184 DOI: 10.1177/03913988211018484] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Cognition influences hospitalization rates for a variety of patient groups but this association has not been examined in heart failure (HF) patients undergoing left ventricular assist device (LVAD) implantation. We used cognition to predict days-alive-out-of-hospital (DAOH) in patients after LVAD surgery. METHODS We retrospectively identified 59 HF patients with cognitive assessment prior to LVAD. Cognitive tests of attention, memory, language, and visual motor speed were averaged into one score. DAOH was converted to a percentage based on total days from LVAD surgery to either heart transplant or 900 days post-LVAD. Variables significantly associated with DAOH in univariate analyses were included in a linear regression model to predict DAOH. RESULTS A linear regression model including LVAD type (continuous or pulsatile flow) and cognition significantly predicted DAOH (F(2,54) = 6.44, p = 0.003, R2 = .19). Inspection of each variable revealed that cognition was a significant predictor in the model (β = .11, SE = .04, p = 0.007) but LVAD type was not (p = 0.08). CONCLUSIONS Cognitive performance assessed prior to LVAD implantation predicted how much time patients spent out of the hospital following surgery. Further studies are warranted to identify the impact of pre-LVAD cognition on post-LVAD hospitalization.
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Affiliation(s)
- Marykay A Pavol
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Amelia K Boehme
- Department of Neurology, Division of Neurology Clinical Outcomes Research and Population Science, Columbia University Irving Medical Center, New York, NY, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Mathew S Maurer
- Department of Medicine, Cardiology Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesus Casida
- School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Joanne R Festa
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Chinwe Ibeh
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
| | - Joshua Z Willey
- Department of Neurology, Stroke Division, Columbia University Irving Medical Center, New York, NY, USA
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15
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Molina EJ, Shah P, Kiernan MS, Cornwell WK, Copeland H, Takeda K, Fernandez FG, Badhwar V, Habib RH, Jacobs JP, Koehl D, Kirklin JK, Pagani FD, Cowger JA. The Society of Thoracic Surgeons Intermacs 2020 Annual Report. Ann Thorac Surg 2021; 111:778-792. [PMID: 33465365 DOI: 10.1016/j.athoracsur.2020.12.038] [Citation(s) in RCA: 363] [Impact Index Per Article: 121.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/22/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
The Society of Thoracic Surgeons (STS)-Interagency Registry for Mechanically Assisted Circulatory Support (Intermacs) 2020 Annual Report reviews outcomes on 25,551 patients undergoing primary isolated continuous-flow left ventricular assist device (LVAD) implantation between 2010 and 2019. In 2019, 3198 primary LVADs were implanted, which is the highest annual volume in Intermacs history. Compared with the previous era (2010-2014), patients who received an LVAD in the most recent era (2015-2019) were more likely to be African American (26.8% vs 22.9%, P < .0001) and more likely to be bridged to durable LVAD with temporary mechanical support devices (36.8% vs 26.0%, P < .0001). In 2019, 50% of patients were INTERMACS Profile 1 or 2 before durable LVAD, and 73% received an LVAD as destination therapy. Magnetic levitation technology has become the predominant design, accounting for 77% of devices in 2019. The 1- and 2-year survival in the most recent era has improved compared with 2010 to 2014 (82.3% and 73.1% vs 80.5% and 69.1%, respectively; P < .0001). Major bleeding and infection continue to be the leading adverse events. Incident stroke has declined in the current era to 12.7% at 1 year. STS-Intermacs research publications are highlighted, and the new quality initiatives are introduced.
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16
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Michelis KC, Zhong L, Tang WW, Young JB, Peltz M, Drazner MH, Pandey A, Griffin J, Maurer MS, Grodin JL. Durable Mechanical Circulatory Support in Patients With Amyloid Cardiomyopathy. Circ Heart Fail 2020; 13:e007931. [DOI: 10.1161/circheartfailure.120.007931] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Many patients with amyloid cardiomyopathy (ACM) develop advanced heart failure, and durable mechanical circulatory support (MCS) may be a consideration. However, data describing clinical outcomes after MCS in this population are limited.
Methods:
Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support with dilated cardiomyopathy (DCM, n=19 921), nonamyloid restrictive cardiomyopathy (RCM, n=248), or ACM (n=46) between 2005 and 2017 were included. Patient and device characteristics were compared between cardiomyopathy groups. The primary end point was the cumulative incidence of death with heart transplantation as a competing risk.
Results:
Patients with ACM (n=46) were older (61 years [interquartile range, 55–69 years] versus 58 years [interquartile range, 49–66 years] for DCM and 55 years [interquartile range, 46–62 years] for nonamyloid RCM,
P
<0.001) and were more commonly Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (30.4% versus 17.9% for DCM and 21.0% for nonamyloid RCM,
P
=0.04) at device implantation. Use of biventricular support (biventricular assist device or total artificial heart) was the highest for patients with ACM (41.3% versus 6.7% and 19.4% for patients with DCM and nonamyloid RCM, respectively,
P
=0.014). The cumulative incidence of death was highest for patients with ACM relative to those with DCM or nonamyloid RCM (
P
<0.001) but did not differ significantly between groups for those who required biventricular MCS.
Conclusions:
Compared with patients with DCM or nonamyloid RCM who received durable MCS, those with ACM experienced the highest use of biventricular support and the worst survival. These data highlight concerns with the use of durable MCS for patients with ACM.
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Affiliation(s)
- Katherine C. Michelis
- Division of Cardiology, Department of Internal Medicine (K.C.M., M.H.D., A.P., J.L.G.), University of Texas Southwestern Medical Center, Dallas
- Division of Cardiology, Department of Internal Medicine, North Texas VA Medical Center, Dallas (K.C.M.)
| | - Lin Zhong
- Division of Bioinformatics, Department of Clinical Sciences (L.Z.), University of Texas Southwestern Medical Center, Dallas
| | - W.H. Wilson Tang
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T., J.B.Y.)
| | - James B. Young
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T., J.B.Y.)
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery (M.P.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H. Drazner
- Division of Cardiology, Department of Internal Medicine (K.C.M., M.H.D., A.P., J.L.G.), University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine (K.C.M., M.H.D., A.P., J.L.G.), University of Texas Southwestern Medical Center, Dallas
| | - Jan Griffin
- Division of Cardiovascular Disease, Department of Internal Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (J.G., M.S.M.)
| | - Mathew S. Maurer
- Division of Cardiovascular Disease, Department of Internal Medicine, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center (J.G., M.S.M.)
| | - Justin L. Grodin
- Division of Cardiology, Department of Internal Medicine (K.C.M., M.H.D., A.P., J.L.G.), University of Texas Southwestern Medical Center, Dallas
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17
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Patel PC, Sareyyupoglu B, Pham SM. Left ventricular assist devices in the elderly: Marching forward with cautions. J Card Surg 2020; 35:3409-3411. [PMID: 32985721 DOI: 10.1111/jocs.15079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
Congestive heart failure is highly prevalent in the elderly population and left ventricular assist device (LVAD) has been increasingly used in this population. LVAD therapy is more costly than medical treatment but it increases the survival and quality of life of the elderly patients with low disease acuity. Therefore careful selection of candidates and implementation of LVAD therapy earlier in the course of the disease is crucial to improve outcomes. With the technical advances and improvement in clinical management, the financial burden of LVAD therapy in the elderly will become less, making this therapy more economically feasible.
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Affiliation(s)
- Parag C Patel
- Departments of Transplantation, Mayo Clinic, Jacksonville, Florida, USA
| | - Basar Sareyyupoglu
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Si M Pham
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, Florida, USA
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18
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Mehmood M. Redefining Left Ventricular Assist Device Indications and Strategies. JAMA Cardiol 2020; 6:119-120. [PMID: 32965462 DOI: 10.1001/jamacardio.2020.4320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Muddassir Mehmood
- Division of Cardiology, Department of Medicine, The University of Tennessee Medical Center, Knoxville
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19
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Galand V, Flécher E, Chabanne C, Lelong B, Goéminne C, Vincentelli A, Delmas C, Dambrin C, Nubret K, Pernot M, Kindo M, Hoang Minh T, Gaudard P, Frapier JM, Michel M, Sénage T, Boignard A, Chavanon O, Verdonk C, Para M, Pelcé E, Gariboldi V, Pozzi M, Obadia JF, Litlzer PY, Anselme F, Babatasi G, Plane AF, Garnier F, Bielefeld M, Hamon D, Radu C, Bourguignon T, Genet T, Eschalier R, D'Ostrevy N, Bories MC, Marijon E, Vanhuyse F, Blangy H, Leclercq C, Martins RP. Septuagenarian population has similar survival and outcomes to younger patients after left ventricular assist device implantation. Arch Cardiovasc Dis 2020; 113:701-709. [PMID: 32952086 DOI: 10.1016/j.acvd.2020.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/20/2020] [Accepted: 05/12/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Left ventricular assist device (LVAD) implantation may be an attractive alternative therapeutic option for elderly patients with heart failure who are ineligible for heart transplantation. AIM We aimed to describe the characteristics and outcomes of elderly patients (i.e. aged≥70 years) receiving an LVAD. METHODS This observational study was conducted in 19 centres between 2006 and 2016. Patients were divided into two groups-younger (aged<70 years) and elderly (aged≥70 years), based on age at time of LVAD implantation. RESULTS A total of 652 patients were included in the final analysis, and 74 patients (11.3%) were aged≥70 years at the time of LVAD implantation (maximal age 77.6 years). The proportion of elderly patients receiving an LVAD each year was constant, with a median of 10.6% (interquartile range 8.0-15.4%) per year, and all were implanted as destination therapy. Elderly and younger patients had similar durations of hospitalization in intensive care units and total lengths of hospital stays. Both age groups experienced similar rates of LVAD-related complications (i.e. stroke, bleeding, driveline infection and LVAD exchange), and the occurrence of LVAD complications did not impact survival in the elderly group compared with the younger group. Lastly, when compared with younger patients implanted as destination therapy, the elderly group also exhibited similar mid-term survival. CONCLUSION This work strongly suggests that selected elderly adults can be scheduled for LVAD implantation.
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Affiliation(s)
- Vincent Galand
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France.
| | - Erwan Flécher
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Chabanne
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Bernard Lelong
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Céline Goéminne
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | - André Vincentelli
- Cardiac Intensive Care Unit, Department of Cardiology, Department of Cardiac Surgery, Institut Coeur-Poumons, CHU de Lille, 59000 Lille, France
| | | | | | - Karine Nubret
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Mathieu Pernot
- LIRYC Institute, Hôpital Cardiologique du Haut-Lévêque, Université de Bordeaux, 33600 Pessac, France
| | - Michel Kindo
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Tam Hoang Minh
- Department of Cardiovascular Surgery, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Philippe Gaudard
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Jean Marc Frapier
- Department of Anaesthesiology, Critical Care Medicine and Cardiac Surgery, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Université de Montpellier, PhyMedExp, INSERM, CNRS, 34090 Montpellier, France
| | - Magali Michel
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Thomas Sénage
- Department of Cardiology and Heart Transplantation Unit, CHU de Nantes, 44093 Nantes, France
| | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Olivier Chavanon
- Department of Cardiology and Cardiovascular Surgery, Hôpital Albert Michallon, CHU de Grenoble, 38700 La Tronche, France
| | - Constance Verdonk
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Marylou Para
- Department of Cardiology and Cardiac Surgery, Hôpital Bichat, 75018 Paris, France
| | - Edeline Pelcé
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Vlad Gariboldi
- Department of Cardiac Surgery, Hôpital de la Timone, 13005 Marseille, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Jean-François Obadia
- Department of Cardiac Surgery, Hôpital Cardio-Vasculaire Louis Pradel, 69500 Bron, France
| | - Pierre Yves Litlzer
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Frédéric Anselme
- Department of Cardiology and Cardiovascular Surgery, Hôpital Charles Nicolle, 76000 Rouen, France
| | - Gerard Babatasi
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Anne Flore Plane
- Department of Cardiology and Cardiac Surgery, Université de Caen and CHU de Caen, 14000 Caen, France
| | - Fabien Garnier
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - Marie Bielefeld
- Department of Cardiology and Cardiac Surgery, CHU de Dijon, 21000 Dijon, France
| | - David Hamon
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Costin Radu
- Department of Cardiology and Cardiac Surgery, Hôpital Henri Mondor, AP-HP, 94010 Créteil, France
| | - Thierry Bourguignon
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Thibaud Genet
- Department of Cardiology and Cardiac Surgery, CHRU de Tours, 37000 Tours, France
| | - Romain Eschalier
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Nicolas D'Ostrevy
- Cardiology Department, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Marie-Cécile Bories
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Eloi Marijon
- Cardiology Department, Hôpital Européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Fabrice Vanhuyse
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Hugues Blangy
- Department of Cardiology and Cardiac Surgery, Hopital de Brabois, CHU de Nancy, 54500 Vandœuvre-lès-Nancy, France
| | - Christophe Leclercq
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
| | - Raphaël P Martins
- LTSI-UMR 1099, INSERM, Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, Université de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France
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20
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Gazda AJ, Kwak MJ, Akkanti B, Nathan S, Kumar S, de Armas IS, Baer P, Patel B, Kar B, Gregoric ID. Complications of LVAD utilization in older adults. Heart Lung 2020; 50:75-79. [PMID: 32709497 DOI: 10.1016/j.hrtlng.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Yearly rate and mean patient age of left ventricular assist device (LVAD) implantation increased from 2009 to 2014. Data are lacking regarding trends of LVAD implantation in older adults. OBJECTIVES To describe the trends of LVAD implantation in older adults and the clinical impact of associated procedural complications. METHODS We retrospectively analyzed the National Inpatient Sample from 2005 to 2014, calculated the percentage of older adults (>65 years of age) among those who underwent LVAD implantation, and compared their clinical characteristics. Primary outcomes were in-hospital mortality and discharge home. RESULTS In total, 4491 patients were included. The percentage of older adults among those receiving LVAD increased from 12.53% to 31.65% (p<0.01). Older adults were more likely to develop postoperative delirium (17.90% vs. 11.92% in younger patients; p<0.01), which portended lesser odds of discharge home. CONCLUSIONS Delirium develops with greater incidence in older adults undergoing LVAD implantation, which decreases odds of favorable discharge disposition.
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Affiliation(s)
- Alexander J Gazda
- Department of Internal Medicine, McGovern Medical School, Houston, TX
| | - Min Ji Kwak
- Department of Internal Medicine: Geriatric and Palliative Care Medicine, McGovern Medical School, 6431 Fannin St MSB 5.126 Houston, TX 77030, USA.
| | - Bindu Akkanti
- Department of Internal Medicine, McGovern Medical School, Houston, TX; Department of Internal Medicine: Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Sriram Nathan
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Sachin Kumar
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Ismael Salas de Armas
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Patrick Baer
- Memorial Hermann Hospital, Trauma Service Line, Houston, TX, USA
| | - Bela Patel
- Department of Internal Medicine, McGovern Medical School, Houston, TX; Department of Internal Medicine: Pulmonary, Critical Care and Sleep Medicine, McGovern Medical School, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapeutics and Transplantation, McGovern Medical School, Houston, TX, USA
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21
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Michelis KC, Zhong L, Peltz M, Pandey A, Tang WHW, Rohatgi A, Young JB, Drazner MH, Grodin JL. Dynamic Forecasts of Survival for Patients Living With Destination Left Ventricular Assist Devices: Insights From INTERMACS. J Am Heart Assoc 2020; 9:e016203. [PMID: 32648531 PMCID: PMC7660737 DOI: 10.1161/jaha.119.016203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Left ventricular assist devices (LVADs) improve outcomes in patients with end-stage heart failure and are increasingly implanted for destination therapy. We describe dynamic estimates of event-free survival with conditional survival probabilities in a destination therapy LVAD population. Methods and Results We studied 8245 adult patients in INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) implanted with a continuous-flow destination therapy LVAD. The composite primary end point was death, device exchange or removal, or heart transplantation. Conditional survival probabilities were calculated and stratified by implantation characteristics and nonfatal adverse events experienced within the first year after implant. Probabilities of surviving an additional 1 to 3 years were numerically higher after longer prior event-free survival. INTERMACS profile 1, extracorporeal membrane oxygenation support, prior or concomitant surgery, and dialysis within 48 hours of implantation were associated with significantly lower event-free survival in the first year but did not impact event-free survival beyond then. For patients who experienced a nonfatal adverse event within the first year, subsequent 1-year conditional survival was lower than in the absence of that event for stroke (65% [95% CI, 57%-73%] versus 75% [95% CI, 73%-77%]; P<0.001), device-related infection (64% [95% CI 57%-71%] versus 76% [95% CI, 74%-78%]; P<0.001), and pump thrombosis or malfunction (64% [95% CI, 57%-70%] versus 76% [95% CI, 74%-78%]; P<0.001). Conclusions Conditional survival in patients with destination therapy LVADs improves over time, even for patients with unfavorable implantation characteristics. However, LVAD-related complications including stroke, device-related infection, and pump thrombosis or malfunction have an enduring negative influence on dynamic estimates of long-term prognosis.
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Affiliation(s)
- Katherine C Michelis
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Lin Zhong
- Division of Bioinformatics Department of Clinical Sciences University of Texas Southwestern Medical Center Dallas TX
| | - Matthias Peltz
- Department of Cardiovascular and Thoracic Surgery University of Texas Southwestern Medical Center Dallas TX
| | - Ambarish Pandey
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - W H Wilson Tang
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH
| | - Anand Rohatgi
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - James B Young
- Department of Cardiovascular Medicine Cleveland Clinic Cleveland OH
| | - Mark H Drazner
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
| | - Justin L Grodin
- Division of Cardiology Department of Internal Medicine University of Texas Southwestern Medical Center Dallas TX
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22
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The Effect of Age on Outcomes After Destination-Therapy Left Ventricular Assist Device Implantation: An Analysis of the IMACS Registry. Can J Cardiol 2020; 37:467-475. [PMID: 32585330 DOI: 10.1016/j.cjca.2020.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND As patients with advanced heart failure are living longer, defining the impact of left ventricular assist devices (LVADs) on outcomes in an aging population is of great importance. We describe overall survival, rates of adverse events (AEs), and post-AE survival in patients age ≥ 70 years vs age 50-69 years after destination-therapy (DT) LVAD implantation. METHODS A retrospective analysis was conducted with the use of the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (IMACS) registry. All adults age ≥ 50 years with a continuous-flow DT LVAD from 2013 to 2017 were included. The primary outcome was all-cause mortality. The secondary outcomes were the incidence of and survival after gastrointestinal (GI) bleeding, infection, stroke, pump thrombosis, pump exchange, and right-side heart failure. Mortality and AEs were assessed with the use of competing risk models. RESULTS At total of 5,572 patients were included: 3,700 aged 50-69 and 1,872 aged ≥ 70. All-cause mortality by 42 months was 55.8% in patients aged ≥ 70 and 44.8% in patients aged 50-69 (P = 0.001). Patients aged ≥ 70 had a 37.8% higher risk of death after DT LVAD implantation (hazard ratio 1.378, 95% CI 1.251-1.517). Patients aged ≥ 70 had higher risk of GI bleeding but lower risk of right-side heart failure. There was no difference between age groups for risk of infection or stroke. Experiencing any AE was associated with an increased risk of death that did not vary with age. CONCLUSIONS Patients aged ≥ 70 years have reduced survival after DT LVAD, in part because of increased GI bleeding, while the incidence of other AEs is similar to that of patients aged 50-69 years. Careful patient selection beyond age alone may allow for optimal outcomes after DT LVAD implantation.
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