Daisuke Yoshioka1, Koichi Toda1, Minoru Ono2, Takeshi Nakatani3, Akira Shiose4, Yoshiro Matsui5, Kenji Yamazaki6, Yoshikatsu Saiki7, Akihiko Usui8, Hiroshi Niinami9, Goro Matsumiya10, Hirokuni Arai11, Yoshiki Sawa1. 1. Department of Cardiovascular Surgery, Osaka University Hospital. 2. The University of Tokyo. 3. Department of Transplantation, National Cardiovascular Research Center. 4. Department of Cardiovascular Surgery, Kyushu University. 5. Department of Cardiovascular Surgery, Hokkaido University. 6. Department of Cardiovascular Surgery, Tokyo Women's Medical University. 7. Department of Cardiovascular Surgery, Tohoku University. 8. Department of Cardiovascular Surgery, Nagoya University Hospital. 9. Department of Cardiovascular Surgery, Saitama Kokusai Medical Center. 10. Department of Cardiovascular Surgery, Chiba University. 11. Department of Cardiovascular Surgery, Tokyo Medical and Dental University.
Abstract
BACKGROUND: Advanced age has an adverse impact on clinical results in left ventricular assist device (LVAD) patients. We compared the clinical results of patients aged >60 years with younger patients using a national Japanese database.Methods and Results: Between April 2013 and December 2016, 300 patients underwent HeartMateII implantation. Of these, 37 patients were ≥60 years at LVAD implantation, and the clinical results of these patients were compared with the other younger 263 patients. At 1 and 3 years the on-device survival was 95%, 91% in younger patients, and 85%, 75% in older patients, respectively (P=0.016), although age was not a risk factor on the multivariate analysis. There was no significant difference between the groups in incidence of various adverse events except stroke. In the propensity-matching cohort, the incidence of stroke was significantly higher in patients aged >60 years (P=0.047). In patients aged >60 years, improvement of renal function was transient and there was no improvement later than 3 months, and recovery of serum albumin level to preoperative value was delayed. CONCLUSIONS: There were significant differences in the stroke incidence and recovery of end-organ functions after LVAD implantation. This may have important implications for patient selection in future destination therapy in Japan, where quality of life is an important issue in LVAD support.
BACKGROUND: Advanced age has an adverse impact on clinical results in left ventricular assist device (LVAD) patients. We compared the clinical results of patients aged >60 years with younger patients using a national Japanese database.Methods and Results: Between April 2013 and December 2016, 300 patients underwent HeartMateII implantation. Of these, 37 patients were ≥60 years at LVAD implantation, and the clinical results of these patients were compared with the other younger 263 patients. At 1 and 3 years the on-device survival was 95%, 91% in younger patients, and 85%, 75% in older patients, respectively (P=0.016), although age was not a risk factor on the multivariate analysis. There was no significant difference between the groups in incidence of various adverse events except stroke. In the propensity-matching cohort, the incidence of stroke was significantly higher in patients aged >60 years (P=0.047). In patients aged >60 years, improvement of renal function was transient and there was no improvement later than 3 months, and recovery of serum albumin level to preoperative value was delayed. CONCLUSIONS: There were significant differences in the stroke incidence and recovery of end-organ functions after LVAD implantation. This may have important implications for patient selection in future destination therapy in Japan, where quality of life is an important issue in LVAD support.
Entities:
Keywords:
Elderly; HeartMate II; J-MACS; Left ventricular assist device