Limited data exist on outcomes in patients greater than 70 years of age supported with continuous flow left ventricular assist devices (LVAD).
Data on 1,149 continuous-flow LVAD recipients was queried from the Mechanical Circulatory Support Research Network. Groups were assigned based on age: ≥70 years (“older patients”) and <70 years. The primary outcome was survival at one-year based on age grouping.
Compared with younger patients, (54.3±11.2years, n=986), older patients (73.4±3.0years) comprised only 14% LVAD implants. Older patients had similar rates of device thrombosis (p=0.47) and stroke (p=0.44) but survival-free of gastrointestinal bleeding (GIB) at one-year was lower when compared to younger patients (58% vs. 69%, p<0.01). Unadjusted survival at one-year in older patients was 75% compared to 84% in younger patients and at two-years 65% versus 73% (p=0.18). Age ≥70 years was not associated with increased mortality (adjHR 0.94, 95%CI:0.70 – 1.26, p=0.67). Pre-operative creatinine (adjHR 1.57, 95%CI:1.30–1.89, p<0.0001), bilirubin (adjHR 1.22, 95%CI:1.05-1.42, p=0.010), and ischemic cardiomyopathy (adjHR 1.43, 95%CI:1.11-1.84, p=0.005) portended increased risk of death. In older patients, the only predictor of mortality was creatinine (HR 2.1, 95%CI:1.2-3.4, p=0.007). A creatinine ≥1.4mg/dl was associated with a one-year survival of 65%, compared to 84% when the creatinine was <1.4mg/dl (p=0.009).
Age over 70 years is an important consideration when assessing LVAD risk but other correlates may be more predictive of LVAD survival. Older patients without renal dysfunction have survival similar to younger patients. Older patients should be counseled age correlated risks, including higher rates of GIB.