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J Thorac Cardiovasc Surg 2005;130:881-882
© 2005 The American Association for Thoracic Surgery
Brief Communication |
Department of Cardiothoracic Surgery, College of Physicians and Surgeons, Columbia University, New York, NY.
Received for publication March 2, 2005; accepted for publication March 7, 2005. * Address for reprints: Yoshifumi Naka, MD, PhD, Herbert Irving Assistant Professor of Surgery, Columbia University, College of Physicians and Surgeons, Director, Mechanical Circulatory Support Program, New York-Presbyterian Hospital, Columbia University Medical Center, 177 Fort Washington Ave, Milstein Hospital 7GN-435, New York, NY 10032 (Email: yn33{at}columbia.edu).
With the rapid growth in the elderly segment of the population, an increasing number of older patients will have end-stage heart failure and require cardiac surgery.
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The demographic of patients undergoing left ventricular assist device (LVAD) implantation is expected to shift toward older and sicker patients in parallel. This study was designed to determine the effect of advanced age on postimplantation complications, bridge-to-transplantation rates, and posttransplantation survival in LVAD recipients.
Patients and Methods
Two hundred one patients undergoing LVAD implantation at a single center from July 1996 through April 2004 were retrospectively reviewed. Patients were categorized according to 3 age cohorts: group 1, less than 40 years; group 2, 40 to 59 years; and group 3, 60 years or older. These groups were then compared with regard to baseline characteristics, LVAD scores,
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postoperative complications, bridge-to-transplantation rates, and posttransplantation survival.
Data were represented as frequency distributions and percentages. Values of continuous variables were expressed as means ± SD. Continuous variables were compared by the analysis of variance test, whereas nominal variables were compared using 
2 tests. Kaplan-Meier analysis was used to calculate long-term survival along with log-rank P values when comparing groups.
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Significant predictors of bridge to transplantation were identified by logistic regression models. All data were analyzed with SPSS 11.5 software (SPSS, Inc, Chicago, Ill).
Results
Demographics
Clinical characteristics of patients are shown in Table 1. The number of patients in groups 1, 2, and 3 was 41 (20.4%), 104 (51.7%), and 56 (27.9%), respectively. There were no significant differences in sex, mean body mass index, and mean LVAD score among the 3 groups. Coronary artery disease as the cause of heart failure was significantly more common in older patients, whereas idiopathic cardiomyopathy and other causes were significantly more common in younger cohorts. There was a greater incidence of hypertension in older patients undergoing LVAD implantation.
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Posttransplantation survival
Posttransplantation actuarial survivals at 1, 3, and 5 years were 93.6%, 86.4%, and 81.1% for group 1; 90.1%, 86.7%, and 78.6% for group 2; and 84.1%, 76.9%, and 69.6% for group 3 (P = .505, log-rank test; Figure 1).
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Discussion
In our review older patients exhibited significantly higher rates of heart failure caused by coronary artery disease, as well as a higher preoperative incidence of hypertension. These findings are consistent with previous reports.
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The mean intensive care unit stay was significantly longer for elderly patients, an outcome likely related to a corresponding increased incidence of postoperative renal failure requiring continuous venovenous hemodialysis. Interestingly, advanced age had no effect on either bridge to transplantation or posttransplantation survival. This might be expected, however, because several recent reports demonstrate comparable posttransplantation survivals for older recipients as a result of improvements in surgical technique, anesthesia management, and perioperative care of patients.
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Preimplantation LVAD score, which has previously been shown to correlate with mortality, was the only independent predictor of outcome but was otherwise comparable among the different age cohorts.
Limitations of this study include those inherent with a retrospective analysis. Data were collected retrospectively by means of chart review and might not be as accurate as data obtained in a prospective and controlled fashion.
In conclusion, LVADs can successfully bridge older patients to transplantation, with posttransplantation survivals equivalent to those achieved by younger LVAD recipients. Decisions to implant LVADs should not be based solely on age; rather, individualized preoperative patient status should be more heavily considered in the decision-making process.
References
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