Periprocedural Outcome after Left Ventricular Assist Device Implantation in Septuagenarians

Objectives: Left ventricular assist device (LVAD) therapy is increasingly used as destination therapy for older patients who are deemed not eligible for subsequent heart transplantation. However, as LVAD implantation is still associated with relevant peri-procedural mortality and morbidity, advanced age is still often regarded as a relative contraindication. Hence, here we analyze the periprocedural outcome of LVAD implantation in septuagenarians.

Methods: Between 01/2010 and 05/2020, a total of 227 patients with terminal heart failure (tHF) were treated in our center with permanent LVAD. Out of those, 27 patients were older than 70 years at the time of implantation (septuagenarians). The periprocedural outcome of those patients was compared with the rest of the LVAD cohort (control group) in a retrospective study.

Result: Mean age of the septuagenarians was 73.1 ± 2.55 years with 81.5% male patients, as compared with 55.3 ± 10.59 years and 87.0% male patients in the control group. Only 11.1% of the septuagenarians had preoperative mechanical circulatory support (vs. 44.5% in the control group, p = 0.001), while implantation was performed in INTERMACS class IV in the majority of patients (40.7 vs. 22.5% in the control group, p = 0.002) with the predominant etiology of tHF being ischemic cardiomyopathy (59.3 vs. 60.5% in the control group, p = 0.90). There were neither significant differences in peri-procedural complications such as need for dialysis (48.1 vs. 54.0%, p = 0.56) or incidence of stroke (14.8 vs. 10.5%, p = 0.50) nor in 30-day mortality (14.8 vs. 12.0%, p = 0.676; septuagenarians vs. control group, respectively). Interestingly, need for intraoperative RVAD was only 11.1% in the septuagenarians versus 26.5% in the control group (p = 0.08), despite significantly higher rates of preoperative RV impairment (63.0 vs. 32.5%, p = 0.002; respectively). However, mid-term survival was significantly reduced in the septuagenarians with 55.6% mortality after a mean follow-up of 2.5 ± 2.5 years versus 32.5% in the control group (p = 0.02).

Conclusion: In our cohort, LVAD implantation in selected septuagenarians showed a comparable periprocedural outcome as to the rest of patients. Hence, advanced age alone should not be considered as a contraindication for destination therapy in elderly patients with tHF. However, more studies are warranted to better define patient selection criteria to further improve clinical outcome in this growing patient population.

Publication History

Article published online:
19 February 2021