How does age affect outcomes after left ventricular assist device implantation: results from the PCHF-VAD registry

Sumant P. Radhoe, Jesse F. Veenis, Nina Jakus, Philippe Timmermans, Anne Catherine Pouleur, Pawel Rubís, Emeline M. Van Craenenbroeck, Edvinas Gaizauskas, Eduardo Barge-Caballero, Stefania Paolillo, Sebastian Grundmann, Domenico D'Amario, Oscar Braun, Aggeliki Gkouziouta, Ivo Planinc, Jure Samardzic, Bart Meyns, Walter Droogne, Karol Wierzbicki, Katarzyna HolcmanAndreas J. Flammer, Hrvoje Gasparovic, Bojan Biocina, Lars H. Lund, Davor Milicic, Frank Ruschitzka, Maja Cikes, Jasper J. Brugts

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)884-894
JournalESC Heart Failure
Volume10
Issue number2
Early online date2022
DOIs
Publication statusPublished - 2023

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Free keywords

  • Advanced heart failure
  • Age
  • Destination therapy
  • Left ventricular assist devices
  • Survival

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