TY - JOUR
T1 - How does age affect outcomes after left ventricular assist device implantation
T2 - results from the PCHF-VAD registry
AU - Radhoe, Sumant P.
AU - Veenis, Jesse F.
AU - Jakus, Nina
AU - Timmermans, Philippe
AU - Pouleur, Anne Catherine
AU - Rubís, Pawel
AU - Van Craenenbroeck, Emeline M.
AU - Gaizauskas, Edvinas
AU - Barge-Caballero, Eduardo
AU - Paolillo, Stefania
AU - Grundmann, Sebastian
AU - D'Amario, Domenico
AU - Braun, Oscar
AU - Gkouziouta, Aggeliki
AU - Planinc, Ivo
AU - Samardzic, Jure
AU - Meyns, Bart
AU - Droogne, Walter
AU - Wierzbicki, Karol
AU - Holcman, Katarzyna
AU - Flammer, Andreas J.
AU - Gasparovic, Hrvoje
AU - Biocina, Bojan
AU - Lund, Lars H.
AU - Milicic, Davor
AU - Ruschitzka, Frank
AU - Cikes, Maja
AU - Brugts, Jasper J.
N1 - Publisher Copyright:
© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2023/4
Y1 - 2023/4
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85143140697&partnerID=8YFLogxK
U2 - 10.1002/ehf2.14247
DO - 10.1002/ehf2.14247
M3 - Article
AN - SCOPUS:85143140697
SN - 2055-5822
VL - 10
SP - 884
EP - 894
JO - ESC heart failure
JF - ESC heart failure
IS - 2
ER -