Should patients 60 years and older undergo bridge to transplantation with continuous-flow left ventricular assist devices?

Jeremiah G. Allen, Arman Kilic, Eric S. Weiss, George J. Arnaoutakis, Timothy J. George, Ashish S. Shah, John V. Conte

Research output: Contribution to journalArticle

Abstract

Background: Although left ventricular assist devices (LVADs) are now commonly used as a bridge to orthotopic heart transplantation (OHT), the upper patient age limit for this therapy has not been defined. Smaller studies have suggested that advanced age should not be a contraindication to bridge to transplantation (BTT) LVAD placement. The purpose of this study was to examine outcomes in patients 60 years and older undergoing BTT with continuous-flow LVADs. Methods: The United Network for Organ Sharing (UNOS) database was reviewed to identify first-time OHT recipients 60 years of age and older (2005-2010). Patients were stratified by preoperative support: continuous-flow LVAD, intravenous inotropic agents, and direct transplantation. Survival after OHT was modeled using the Kaplan-Meier method. All-cause mortality was examined using multivariable Cox proportional hazard regression. Results: Of 2,554 patients, 1,142 (44.7%) underwent direct transplantation, 264 (10.3%) had LVAD BTT, and 1,148 (45.0%) had BTT with inotropic agents. The mean age was 64 ± 3 years, and 460 (18.0%) patients were women. Mean follow-up was 29 ± 19 months. Survival differed significantly among the 3 groups. Patients with LVAD BTT had significantly lower survival after OHT compared with the other groups at 30 days and 1 year. This survival difference was no longer significant at 2 years after OHT or when deaths in the first 30 days were censored. LVAD BTT increased the hazard of death at 1 year by 50% (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.05-2.15; p = 0.03), compared with patients who underwent direct transplantation. Conclusions: This study represents the largest modern cohort in which survival after OHT has been evaluated in patients 60 years or older who received BTT. Older patients have lower short-term survival after OHT when BTT is carried out with a continuous-flow LVAD compared with inotropic agents or direct transplantation.

Original languageEnglish (US)
Pages (from-to)2017-2024
Number of pages8
JournalAnnals of Thoracic Surgery
Volume94
Issue number6
DOIs
StatePublished - Dec 1 2012

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Should patients 60 years and older undergo bridge to transplantation with continuous-flow left ventricular assist devices?'. Together they form a unique fingerprint.

  • Cite this

    Allen, J. G., Kilic, A., Weiss, E. S., Arnaoutakis, G. J., George, T. J., Shah, A. S., & Conte, J. V. (2012). Should patients 60 years and older undergo bridge to transplantation with continuous-flow left ventricular assist devices? Annals of Thoracic Surgery, 94(6), 2017-2024. https://doi.org/10.1016/j.athoracsur.2012.06.009