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Short‐term mechanical circulatory support in elderly patients
Background Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short‐term MCS. Methods Retrospective analysis of ≥70‐y...
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| Published in: | Artificial organs 2022-05, Vol.46 (5), p.867-877 |
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| container_end_page | 877 |
| container_issue | 5 |
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| container_title | Artificial organs |
| container_volume | 46 |
| creator | Alonso‐Fernandez‐Gatta, Marta Merchan‐Gomez, Soraya Toranzo‐Nieto, Ines Gonzalez‐Cebrian, Miryam Diego‐Nieto, Alejandro Barrio, Alfredo Martin‐Herrero, Francisco Sanchez, Pedro L. |
| description | Background
Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short‐term MCS.
Methods
Retrospective analysis of ≥70‐year‐old patients supported with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients ( |
| doi_str_mv | 10.1111/aor.14117 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2597811586</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2597811586</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3537-910d40c17eced810022113f564877b469be86fb03d41598866242b266145d4743</originalsourceid><addsrcrecordid>eNp10MtKw0AUBuBBFFurC19AAm50EXtOMpdkJaV4g0LBC7gbksmUpuTmTIJk5yP4jD6Jo6kuBGczm4___PyEHCNcoHvTpDYXSBHFDhkjC5iPLKa7ZAzIwWecPo_IgbUbABAU-D4ZhVREADGMyeXDujbtx9t7q03plVqtkypXSeGp3KiuSNra9J7tmsYpL688XWTaFL3XJG2uq9Yekr1VUlh9tP0n5On66nF-6y-WN3fz2cJXIQuFHyNkFBQKrXQWIUAQIIYr1y0SIqU8TnXEVymEGXXdo4jzgAZpwDlSllFBwwk5G3IbU7902rayzK3SRZFUuu6sDFgsIkQWcUdP_9BN3ZnKtZOBu8cYAAenzgelTG2t0SvZmLxMTC8R5Neq0q0qv1d19mSb2KWlzn7lz4wOTAfwmhe6_z9Jzpb3Q-QnPQ1_aQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2648550060</pqid></control><display><type>article</type><title>Short‐term mechanical circulatory support in elderly patients</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Alonso‐Fernandez‐Gatta, Marta ; Merchan‐Gomez, Soraya ; Toranzo‐Nieto, Ines ; Gonzalez‐Cebrian, Miryam ; Diego‐Nieto, Alejandro ; Barrio, Alfredo ; Martin‐Herrero, Francisco ; Sanchez, Pedro L.</creator><creatorcontrib>Alonso‐Fernandez‐Gatta, Marta ; Merchan‐Gomez, Soraya ; Toranzo‐Nieto, Ines ; Gonzalez‐Cebrian, Miryam ; Diego‐Nieto, Alejandro ; Barrio, Alfredo ; Martin‐Herrero, Francisco ; Sanchez, Pedro L.</creatorcontrib><description>Background
Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short‐term MCS.
Methods
Retrospective analysis of ≥70‐year‐old patients supported with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group.
Results
Out of 164 short‐term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70‐year‐old patients (73.3% VA‐ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high‐risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow‐up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log‐rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post‐implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high‐risk PCI had higher survival compared to other indications (p = 0.013).
Conclusion
Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
Retrospective analysis of ≥70 year old patients under short‐term mechanical circulatory support (MCS): veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® in a referral hospital (elderly group), compared with younger patients (<70 years). Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.</description><identifier>ISSN: 0160-564X</identifier><identifier>EISSN: 1525-1594</identifier><identifier>DOI: 10.1111/aor.14117</identifier><identifier>PMID: 34780090</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Age ; Aged ; cardiogenic shock ; Complications ; Contraindications ; Creatinine ; elderly ; Extracorporeal membrane oxygenation ; Heart ; Heart-Assist Devices - adverse effects ; Hemodynamics ; Humans ; impella ; Lactic acid ; mechanical circulatory support ; Medical prognosis ; Mortality ; Older people ; Oxygenation ; Patients ; Percutaneous Coronary Intervention - adverse effects ; Recovery ; Retrospective Studies ; Risk ; Shock, Cardiogenic - etiology ; Shock, Cardiogenic - surgery ; Stroke Volume ; Survival ; Transplants & implants ; Treatment Outcome ; Vascular diseases ; VA‐ECMO ; Ventricle ; Ventricular Function, Left</subject><ispartof>Artificial organs, 2022-05, Vol.46 (5), p.867-877</ispartof><rights>2021 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.</rights><rights>2022 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3537-910d40c17eced810022113f564877b469be86fb03d41598866242b266145d4743</citedby><cites>FETCH-LOGICAL-c3537-910d40c17eced810022113f564877b469be86fb03d41598866242b266145d4743</cites><orcidid>0000-0002-4363-8835</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34780090$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Alonso‐Fernandez‐Gatta, Marta</creatorcontrib><creatorcontrib>Merchan‐Gomez, Soraya</creatorcontrib><creatorcontrib>Toranzo‐Nieto, Ines</creatorcontrib><creatorcontrib>Gonzalez‐Cebrian, Miryam</creatorcontrib><creatorcontrib>Diego‐Nieto, Alejandro</creatorcontrib><creatorcontrib>Barrio, Alfredo</creatorcontrib><creatorcontrib>Martin‐Herrero, Francisco</creatorcontrib><creatorcontrib>Sanchez, Pedro L.</creatorcontrib><title>Short‐term mechanical circulatory support in elderly patients</title><title>Artificial organs</title><addtitle>Artif Organs</addtitle><description>Background
Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short‐term MCS.
Methods
Retrospective analysis of ≥70‐year‐old patients supported with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group.
Results
Out of 164 short‐term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70‐year‐old patients (73.3% VA‐ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high‐risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow‐up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log‐rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post‐implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high‐risk PCI had higher survival compared to other indications (p = 0.013).
Conclusion
Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
Retrospective analysis of ≥70 year old patients under short‐term mechanical circulatory support (MCS): veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® in a referral hospital (elderly group), compared with younger patients (<70 years). Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.</description><subject>Age</subject><subject>Aged</subject><subject>cardiogenic shock</subject><subject>Complications</subject><subject>Contraindications</subject><subject>Creatinine</subject><subject>elderly</subject><subject>Extracorporeal membrane oxygenation</subject><subject>Heart</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Hemodynamics</subject><subject>Humans</subject><subject>impella</subject><subject>Lactic acid</subject><subject>mechanical circulatory support</subject><subject>Medical prognosis</subject><subject>Mortality</subject><subject>Older people</subject><subject>Oxygenation</subject><subject>Patients</subject><subject>Percutaneous Coronary Intervention - adverse effects</subject><subject>Recovery</subject><subject>Retrospective Studies</subject><subject>Risk</subject><subject>Shock, Cardiogenic - etiology</subject><subject>Shock, Cardiogenic - surgery</subject><subject>Stroke Volume</subject><subject>Survival</subject><subject>Transplants & implants</subject><subject>Treatment Outcome</subject><subject>Vascular diseases</subject><subject>VA‐ECMO</subject><subject>Ventricle</subject><subject>Ventricular Function, Left</subject><issn>0160-564X</issn><issn>1525-1594</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNp10MtKw0AUBuBBFFurC19AAm50EXtOMpdkJaV4g0LBC7gbksmUpuTmTIJk5yP4jD6Jo6kuBGczm4___PyEHCNcoHvTpDYXSBHFDhkjC5iPLKa7ZAzIwWecPo_IgbUbABAU-D4ZhVREADGMyeXDujbtx9t7q03plVqtkypXSeGp3KiuSNra9J7tmsYpL688XWTaFL3XJG2uq9Yekr1VUlh9tP0n5On66nF-6y-WN3fz2cJXIQuFHyNkFBQKrXQWIUAQIIYr1y0SIqU8TnXEVymEGXXdo4jzgAZpwDlSllFBwwk5G3IbU7902rayzK3SRZFUuu6sDFgsIkQWcUdP_9BN3ZnKtZOBu8cYAAenzgelTG2t0SvZmLxMTC8R5Neq0q0qv1d19mSb2KWlzn7lz4wOTAfwmhe6_z9Jzpb3Q-QnPQ1_aQ</recordid><startdate>202205</startdate><enddate>202205</enddate><creator>Alonso‐Fernandez‐Gatta, Marta</creator><creator>Merchan‐Gomez, Soraya</creator><creator>Toranzo‐Nieto, Ines</creator><creator>Gonzalez‐Cebrian, Miryam</creator><creator>Diego‐Nieto, Alejandro</creator><creator>Barrio, Alfredo</creator><creator>Martin‐Herrero, Francisco</creator><creator>Sanchez, Pedro L.</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-4363-8835</orcidid></search><sort><creationdate>202205</creationdate><title>Short‐term mechanical circulatory support in elderly patients</title><author>Alonso‐Fernandez‐Gatta, Marta ; Merchan‐Gomez, Soraya ; Toranzo‐Nieto, Ines ; Gonzalez‐Cebrian, Miryam ; Diego‐Nieto, Alejandro ; Barrio, Alfredo ; Martin‐Herrero, Francisco ; Sanchez, Pedro L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3537-910d40c17eced810022113f564877b469be86fb03d41598866242b266145d4743</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Age</topic><topic>Aged</topic><topic>cardiogenic shock</topic><topic>Complications</topic><topic>Contraindications</topic><topic>Creatinine</topic><topic>elderly</topic><topic>Extracorporeal membrane oxygenation</topic><topic>Heart</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Hemodynamics</topic><topic>Humans</topic><topic>impella</topic><topic>Lactic acid</topic><topic>mechanical circulatory support</topic><topic>Medical prognosis</topic><topic>Mortality</topic><topic>Older people</topic><topic>Oxygenation</topic><topic>Patients</topic><topic>Percutaneous Coronary Intervention - adverse effects</topic><topic>Recovery</topic><topic>Retrospective Studies</topic><topic>Risk</topic><topic>Shock, Cardiogenic - etiology</topic><topic>Shock, Cardiogenic - surgery</topic><topic>Stroke Volume</topic><topic>Survival</topic><topic>Transplants & implants</topic><topic>Treatment Outcome</topic><topic>Vascular diseases</topic><topic>VA‐ECMO</topic><topic>Ventricle</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Alonso‐Fernandez‐Gatta, Marta</creatorcontrib><creatorcontrib>Merchan‐Gomez, Soraya</creatorcontrib><creatorcontrib>Toranzo‐Nieto, Ines</creatorcontrib><creatorcontrib>Gonzalez‐Cebrian, Miryam</creatorcontrib><creatorcontrib>Diego‐Nieto, Alejandro</creatorcontrib><creatorcontrib>Barrio, Alfredo</creatorcontrib><creatorcontrib>Martin‐Herrero, Francisco</creatorcontrib><creatorcontrib>Sanchez, Pedro L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Alonso‐Fernandez‐Gatta, Marta</au><au>Merchan‐Gomez, Soraya</au><au>Toranzo‐Nieto, Ines</au><au>Gonzalez‐Cebrian, Miryam</au><au>Diego‐Nieto, Alejandro</au><au>Barrio, Alfredo</au><au>Martin‐Herrero, Francisco</au><au>Sanchez, Pedro L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Short‐term mechanical circulatory support in elderly patients</atitle><jtitle>Artificial organs</jtitle><addtitle>Artif Organs</addtitle><date>2022-05</date><risdate>2022</risdate><volume>46</volume><issue>5</issue><spage>867</spage><epage>877</epage><pages>867-877</pages><issn>0160-564X</issn><eissn>1525-1594</eissn><abstract>Background
Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short‐term MCS.
Methods
Retrospective analysis of ≥70‐year‐old patients supported with veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group.
Results
Out of 164 short‐term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70‐year‐old patients (73.3% VA‐ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high‐risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow‐up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log‐rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post‐implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high‐risk PCI had higher survival compared to other indications (p = 0.013).
Conclusion
Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
Retrospective analysis of ≥70 year old patients under short‐term mechanical circulatory support (MCS): veno‐arterial extracorporeal membrane oxygenation (VA‐ECMO) or Impella CP® in a referral hospital (elderly group), compared with younger patients (<70 years). Short‐term MCS with VA‐ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high‐risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>34780090</pmid><doi>10.1111/aor.14117</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-4363-8835</orcidid></addata></record> |
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| ispartof | Artificial organs, 2022-05, Vol.46 (5), p.867-877 |
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| subjects | Age Aged cardiogenic shock Complications Contraindications Creatinine elderly Extracorporeal membrane oxygenation Heart Heart-Assist Devices - adverse effects Hemodynamics Humans impella Lactic acid mechanical circulatory support Medical prognosis Mortality Older people Oxygenation Patients Percutaneous Coronary Intervention - adverse effects Recovery Retrospective Studies Risk Shock, Cardiogenic - etiology Shock, Cardiogenic - surgery Stroke Volume Survival Transplants & implants Treatment Outcome Vascular diseases VA‐ECMO Ventricle Ventricular Function, Left |
| title | Short‐term mechanical circulatory support in elderly patients |
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