Clinical Strategies and Outcomes in Advanced Heart Failure Patients Older Than 70 Years of Age Receiving the HeartMate II Left Ventricular Assist Device

Abstract

The LVAD patients ≥ 70 years of age have good functional recovery, survival, and quality of life at 2 years. Advanced age should not be used as an independent contraindication when selecting a patient for LVAD therapy at experienced centers.

Present-Day Hospital Readmissions after Left Ventricular Assist Device Implantation: A Large Single-Center Study

“…These milestones initiated modern LVAD therapy, enabling this treatment to become available to a larger population of patients. [5][6][7][8][9] Consequently, LVAD use has dramatically increased throughout the world, particularly for DT, and growing numbers of medical centers are offering device therapy. [9][10][11] This trend has been bolstered by reports that LVAD use, in HF patients 70 years of age or older, is associated with…”

“…8 After recovering from the implantation procedure, most patients have improved hemodynamic values and endorgan perfusion. 4,12,13 Improvements in survival rates are even better than those documented in the pivotal clinical trials (1-year survival rate, 68%-74% before FDA approval vs 85% after approval).…”

Advanced Heart Failure Treatment Options Among the Elderly

“…Adamson et al 34 described a single-center experience using HeartMate II in 30 patients over age 70 (mean 76 ± 3.9 years). Comparing this cohort with a younger cohort (mean 56.7 ± 14.3 years), older age was associated with nearly identical hospital length of stay, 1-and 2-year survival, and major complications (bleeding, infection, arrhythmia, renal failure, right heart failure and stroke).…”

“…Authors also highlighted center experience and the rigorous evaluation by a dedicated multidisciplinary health care team to assess and optimize neurologic, nutritional, psychosocial and renal function as factors for successful outcomes. 34 Using the largest allpayer database in the United States, Kilic et al 35 observed comparable mortality, with no independent impact of age on inpatient mortality, when comparing elderly patients (age > 70, n=1,472) to a younger group (age 60-69, n=2,787) supported with continuous-flow LVAD. Somewhat contradictory data was published by Atluri et al, 36 who examined the INTERMACS national registry from 2006 to 2012 and similarly dichotomized patient groups into age > 70 (n=590) and age < 70 (n=4,439).…”

“…58 However, Flint et al cautioned that the predictive value of frailty in LVAD patients is complicated by the fact that the underlying cardiac disease contributing to a patient's frailty may itself be reversed as a result of LVAD therapy. 48 Accordingly, recent studies have challenged the traditional notion that age is a predictor of mortality and adverse outcomes in patients who receive LVAD as destination therapy 34,59 and have suggested frailty may be a superior metric in preoperative assessment.…”