The Effect of Age on Outcomes After Destination-Therapy Left Ventricular Assist Device Implantation: An Analysis of the IMACS Registry

• Published in: Canadian journal of cardiology 2021-03, Vol.37 (3), p.467-475
• Main Authors: Aleksova, Natasha, Alba, Ana C., Fan, Chun-Po S., Amin, Faizan, Kiamanesh, Omid, McGuinty, Caroline, Lee, Hanna, Duero Posada, Juan G., Ross, Heather J., Billia, Filio, Rao, Vivek
• Format: Article
• Language: English
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2020.06.010

As patients with advanced heart failure are living longer, defining the impact of left ventricular assist devices (LVADs) on outcomes in an aging population is of great importance. We describe overall survival, rates of adverse events (AEs), and post-AE survival in patients age ≥ 70 years vs age 50-69 years after destination-therapy (DT) LVAD implantation. A retrospective analysis was conducted with the use of the International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (IMACS) registry. All adults age ≥ 50 years with a continuous-flow DT LVAD from 2013 to 2017 were included. The primary outcome was all-cause mortality. The secondary outcomes were the incidence of and survival after gastrointestinal (GI) bleeding, infection, stroke, pump thrombosis, pump exchange, and right-side heart failure. Mortality and AEs were assessed with the use of competing risk models. At total of 5,572 patients were included: 3,700 aged 50-69 and 1,872 aged ≥ 70. All-cause mortality by 42 months was 55.8% in patients aged ≥ 70 and 44.8% in patients aged 50-69 (P = 0.001). Patients aged ≥ 70 had a 37.8% higher risk of death after DT LVAD implantation (hazard ratio 1.378, 95% CI 1.251-1.517). Patients aged ≥ 70 had higher risk of GI bleeding but lower risk of right-side heart failure. There was no difference between age groups for risk of infection or stroke. Experiencing any AE was associated with an increased risk of death that did not vary with age. Patients aged ≥ 70 years have reduced survival after DT LVAD, in part because of increased GI bleeding, while the incidence of other AEs is similar to that of patients aged 50-69 years. Careful patient selection beyond age alone may allow for optimal outcomes after DT LVAD implantation. Comme les patients atteints d’insuffisance cardiaque avancée vivent plus longtemps, il est d’autant plus important de définir les répercussions des dispositifs d’assistance ventriculaire gauche (DAVG) sur les résultats au sein d’une population vieillissante. Nous décrivons la survie globale, les taux d’événements indésirables (ÉI) et la survie post-ÉI des patients âgés de ≥ 70 ans vs les patients âgés de 50 à 69 ans après l’implantation permanente (IP) du DAVG. Nous avons réalisé une analyse rétrospective à l’aide du registre de l’International Society for Heart and Lung Transplantation Mechanically Assisted Circulatory Support (IMACS). Nous avons inclus tous les adultes âgés ≥ 50 ans qui ont eu une IP du DA