Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
Ann Thorac Surg. 2013 Jul;96(1):141-7. doi: 10.1016/j.athoracsur.2013.04.010. Epub 2013 May 31.
There are an increasing number of elderly patients with end-stage heart failure. Destination mechanical circulatory support is often the only therapy available for these patients who are not transplant candidates. The outcomes after continuous flow left ventricular assist device (CF LVAD) implant in older patients remains unclear. We undertook this multi-institutional study to quantify short-term and midterm outcomes after CF LVAD implant in the elderly.
We retrospectively analyzed all patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) national registry that underwent implant of a CF LVAD (June 2006 to April 2012). Patients were divided into 2 cohorts based upon age (<70 years [n = 4,439] and ≥ 70 years (n = 590]). Preoperative, intraoperative, and postoperative variables were analyzed. The primary endpoint, survival, was compared between cohorts.
Patients age 70 and older were more hemodynamically stable pre-VAD implant as evidenced by INTERMACS profile and inotrope dependence. Perioperative outcomes, including median bypass time (89 vs 89 minutes) and length of stay (0.657 vs 0.657 months) were similar between cohorts (p = not significant). Kaplan-Meier analysis revealed a significant difference in 2-year survival between patients aged 70 years or greater (63%) and less than 70 (71%, p < 0.001). Multivariable Cox proportional hazard analysis revealed age as an independent predictor of mortality during follow-up (p < 0.001). Nonetheless, midterm cumulative survival in the older cohort was still reasonable (63% at 2 years).
Multi-institutional analysis revealed advanced age as a predictor of increased mortality after CF LVAD implantation. Careful patient selection is critical in the elderly to optimize long-term outcomes after CF LVAD implantation.
越来越多的老年终末期心力衰竭患者需要接受机械循环支持治疗。对于不符合心脏移植条件的这些患者，通常只能采用连续性左心室辅助装置（CF-LVAD）进行治疗。目前，老年患者接受 CF-LVAD 植入术后的短期和中期预后仍不明确。本研究旨在多中心分析老年患者接受 CF-LVAD 植入术后的短期和中期预后。
我们回顾性分析了 INTERMACS 国家注册数据库中所有接受 CF-LVAD 植入术的患者（2006 年 6 月至 2012 年 4 月）。根据年龄将患者分为两组（<70 岁[n=4439]和≥70 岁[n=590]）。分析患者术前、术中及术后的相关变量。比较两组患者的主要终点（生存率）。
与年龄<70 岁的患者相比，年龄≥70 岁的患者在植入 CF-LVAD 前血流动力学更稳定，表现为 INTERMACS 评分更高且对正性肌力药物的依赖程度更低。两组患者的围手术期结局相似，包括体外循环时间（89 分钟对 89 分钟）和住院时间（0.657 个月对 0.657 个月）（p=无显著差异）。Kaplan-Meier 分析显示，年龄≥70 岁的患者 2 年生存率（63%）显著低于年龄<70 岁的患者（71%，p<0.001）。多变量 Cox 比例风险分析显示，年龄是随访期间死亡的独立预测因素（p<0.001）。尽管如此，年龄较大组患者的中期累积生存率仍相对较高（2 年时为 63%）。
多中心分析显示，年龄是 CF-LVAD 植入术后死亡率增加的预测因素。在老年患者中，仔细的患者选择对于优化 CF-LVAD 植入术后的长期预后至关重要。
