- 作者：Sigrid E. S ; ner ; Daniel Zimpfer ; Philipp Zrunek ; Angela Rajek ; Heinrich Schima ; Daniela Dunkler ; Andreas O. Zuckermann ; Georg M. Wieselthaler
- 刊名：The Journal of Heart and Lung Transplantation
- 出版年：2009
- 出版时间：April 2009
- 年：2009
- 卷：28
- 期：4
- 页码：367-372
- 全文大小：242 K
Objective
The effect of age on outcomes after continuous-flow left ventricular assist device (LVAD) implantation as a bridge to transplantation (BTT) was determined.Methods
From November 1998 to July 2007, 86 patients with advanced heart failure underwent continuous-flow LVAD implantation as BTT and were retrospectively analyzed. Patients were categorized into 2 groups by age at LVAD implantation: 56 patients (65.1 % ) younger than 60, Group 1; and 30 (34.9 % ) aged 60 years or older, Group 2.
Results
Group 2 patients had a higher incidence of heart failure caused by ischemic heart disease (63.3 % vs 32.1 % , p = 0.005) and more severely impaired renal function by Modification of Diet in Renal Disease-derived glomerular filtration rates (51.9 ± 15.9 vs. 68.0 ± 20.5 ml/min/1.73 m2, p < 0.001) than Group 1. Age was the only independent predictor of post-LVAD death (hazard ratio, 1.4 p = 0.003). The BTT rate was lower (33.3 % vs 62.5 % , p = 0.010), and incidence of post-LVAD renal failure was higher (53.3 % vs 30.4 % , p = 0.037) in Group 2 vs Group 1. Post-LVAD survival at 1, 3, and 6 months was 92.9 % , 79.9 % , and 74.0 % for Group 1 and 90.0 % , 62.0 % , and 37.0 % for Group 2 (p = 0.007). Post-transplant survival at 1, 3, and 5 years was 87.8 % , 82.3 % , and 76.0 % for Group 1 and 90.0 % , 67.5 % , 67.5 % for Group 2 (p = 0.517).
Conclusions
Patients aged 60 years and older have inferior post-LVAD survival; however, post-transplant survival is excellent. We advocate LVAD placement as bridge-to-transplant therapy only in carefully selected older patients most well suited for transplantation.