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J Cardiovasc Surg (Torino). 2019 Apr;60(2):251-258. doi: 10.23736/S0021-9509.18.10593-3. Epub 2018 Aug 29.

Which advanced heart failure therapy strategy is optimal for patients over 60 years old?

Author information

1
Division of Cardiothoracic Surgery, Department of Surgery, University of California San Diego, Sulpizio Cardiovascular Center, La Jolla, CA, USA - yako@ucsd.edu.
2
Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
3
Department of Cardiology, University of California San Diego, Sulpizio Cardiovascular Center, La Jolla, CA, USA.
4
Division of Cardiothoracic Surgery, Department of Surgery, University of California San Diego, Sulpizio Cardiovascular Center, La Jolla, CA, USA.

Abstract

BACKGROUND:

The optimal advanced heart failure (HF) therapy strategy for patients aged 60 or older with end-stage HF refractory to optimal medical therapy remains uncertain. This study compares outcomes of three advanced HF therapy strategies in this patient population.

METHODS:

A single-center retrospective study was conducted in 95 patients aged 60-73 years who had undergone isolated heart transplantation (HTx) or continuous flow left ventricular assist device (LVAD) implantation from 2010 to 2017. Patients were stratified into three cohorts by strategy; HTx-only (N.=25), LVAD-to-HTx (N.=29), and LVAD-only (N.=41). Primary end point was 2-year overall survival. Secondary end points included incidence of post-operative adverse events, freedom from first readmission at 1 year, and percentage of days spent in hospital following advanced HF therapy.

RESULTS:

Two-year survival was 91% in HTx-only patients, 88% in LVAD-to-HTx patients, and 49% in LVAD-only patients (P=0.0008). No significant difference in post-transplant survival was found between patients with or without LVAD-related adverse events preceding transplantation (P=0.42). One-year freedom from first readmission was 38.3% in HTx-only patients, 17.2% in LVAD-to-HTx patients and 7.3% in LVAD-only patients (P=0.0028). Patients in LVAD-to-HTx cohort had higher incidences of gastrointestinal bleeding (38% vs. 3%; P<0.01), major bleeding (28% vs. 3%; P=0.02), and right heart failure (69% vs. 31%; P<0.01) during post-LVAD period compared with post-HTx period. Their percentage of days spent in hospital during post-LVAD period was significantly higher than post-HTx period (7.9% vs. 1.2%; P<0.001).

CONCLUSIONS:

Our experience with patients over 60 years old undergoing advanced therapy suggests that HTx-only and LVAD-to-HTx strategies had superior medium-term survival than LVAD-only strategy. LVAD-to-HTx strategy is effective in reducing incidence of adverse events and percentage of hospitalized days in this specific patient population.

PMID:
30168306
DOI:
10.23736/S0021-9509.18.10593-3
[Indexed for MEDLINE]

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