Contemporary Left Ventricular Assist Device Outcomes in an Aging Population,Journal of the American College of Cardiology

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Contemporary Left Ventricular Assist Device Outcomes in an Aging Population
Journal of the American College of Cardiology ( IF 21.7 ) Pub Date : 2021-08-23 , DOI: 10.1016/j.jacc.2021.06.035
Dominic Emerson ₁ , Joanna Chikwe ₁ , Pedro Catarino ₁ , Mohamed Hassanein ₁ , Luqin Deng ₂ , Ryan S Cantor ₂ , Amy Roach ₁ , Robert Cole ₁ , Fardad Esmailian ₁ , Jon Kobashigawa ₁ , Jaime Moriguchi ₁ , James K Kirklin ₂

Affiliation

Background

Survival, functional outcomes, and quality of life after left ventricular assist device (LVAD) are ill-defined in elderly patients, and with new-generation devices.

Objectives

This study sought to evaluate survival, functional outcomes, and quality of life after LVAD in contemporary practice.

Methods

Adults receiving durable LVADs between January 1, 2010, and March 1, 2020, were identified from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database. The primary outcome was adjusted survival; secondary outcomes included quality of life rated using a visual analogue scale (where 0 represents “worst health” and 100 “best health”); 6-minute walk distance; stroke; device malfunction; and rehospitalization, stratified by patient age. Median follow-up was 15 months (IQR: 6-32 months).

Results

The cohort comprised 68.9% (n = 16,808) patients aged <65 years, 26.3% (n = 6,418) patients aged 65-75 years, and 4.8% (n = 1,182) patients aged >75 years, who were predominantly male (n = 19,119, 78%) and on destination therapy (n = 12,425, 51%). Competing outcomes analysis demonstrated mortality (70% CIs) of 34% (33%-34%), 54% (54%-55%), and 66% (64%-68%) for patients aged <65, 65-75, and >75 years, respectively, which improved during the study in patients aged >75 years. Newer-generation devices were associated with reduced late mortality (HR: 0.35; 95% CI: 0.25-0.49). Stroke, device malfunction or thrombosis, and rehospitalizations decreased with increasing age (all P < 0.01). Median 6-minute walk distance increased from 0 feet (IQR: 0-665 feet) to 1,065 feet (IQR: 642-1,313 feet) (P < 0.001), and quality of life improved from 40 (IQR: 15-60) to 75 (IQR: 60-90) (P < 0.001) after LVAD in all age groups.

Conclusions

In elderly patients, LVADs are associated with increased functional capacity, similar improvements in quality of life, and fewer complications compared with younger patients.

中文翻译：

现代左心室辅助装置在老龄化人群中的结果

背景

左心室辅助装置 (LVAD) 后的生存率、功能结果和生活质量在老年患者和新一代装置中都没有明确定义。

目标

本研究旨在评估当代实践中 LVAD 后的生存率、功能结果和生活质量。

方法

从 INTERMACS（机械辅助循环支持机构间登记处）数据库中确定了在 2010 年 1 月 1 日至 2020 年 3 月 1 日期间接受持久 LVAD 的成年人。主要结果是调整后的生存率；次要结果包括使用视觉模拟量表评定的生活质量（其中 0 代表“最差健康”，100 代表“最佳健康”）；6分钟步行距离；中风; 设备故障；和再住院，按患者年龄分层。中位随访时间为 15 个月（IQR：6-32 个月）。

结果

该队列包括 68.9% (n = 16,808) 名 <65 岁的患者、26.3% (n = 6,418) 名 65-75 岁的患者和 4.8% (n = 1,182) 名 > 75 岁的患者，这些患者主要是男性 (n = 19,119, 78%）和目的地治疗（n = 12,425, 51%）。竞争结果分析表明，<65、65-75 岁患者的死亡率 (70% CI) 为 34% (33%-34%)、54% (54%-55%) 和 66% (64%-68%)和 > 75 岁，在研究期间对年龄 > 75 岁的患者有所改善。新一代设备与降低晚期死亡率相关（HR：0.35；95% CI：0.25-0.49）。中风、设备故障或血栓形成以及再住院率随着年龄的增长而减少（所有 P < 0.01）。6 分钟步行距离的中位数从 0 英尺（IQR：0-665 英尺）增加到 1,065 英尺（IQR：642-1,313 英尺）（P < 0.001)，所有年龄组的 LVAD 后生活质量从 40 (IQR: 15-60) 提高到 75 (IQR: 60-90) ( P < 0.001)。