Objectives

The purpose of this study was to examine outcomes after left ventricular assist device (LVAD) implantation in older adults (>75 years of age).

Background

An aging heart failure population together with improvements in mechanical circulatory support (MCS) technology have led to increasing LVAD implantations in older adults. However, data presenting age-specific outcomes are limited.

Methods

Adult patients in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) who required durable MCS between 2008 and 2017 were included. Patients were stratified by 4 age groups: <55 years of age, 55 to 64 years of age, and >75 years of age. Kaplan-Meier survival estimates were used to assess post-LVAD outcomes, with log-rank testing used to compare groups. Univariate and multivariate cox proportional hazard regression models were used to determine predictors of survival and complications.

Results

A total of 20,939 individuals received an LVAD during the study period: 7,743 (37.0%) were <55 years of age, 6,755 (32.3%) were 55 to 64 years of age, 5,418 (25.9%) were 65 to 74 years of age, and 1,023 (4.9%) were ≥75 years of age or older. After multivariate adjustment, adults ≥75 years of age had increased mortality post-LVAD implantation. Elderly patients with LVADs had a higher incidence of gastrointestinal bleeding but lower rates of device thrombosis. Compared to 84.5% of patients <55 years of age who were discharged home, only 46.8% of adults ≥75 years of age were discharged home following implantation (p < 0.001). Use of a RVAD, serum albumin level, and 6-min walk test distances were identified as predictors of outcomes in the oldest cohort.

Conclusions

Despite careful selection of older adults for LVAD implantation, age remains a significant predictor of mortality. Higher bleeding and lower clotting risk in elderly patients with LVADs support the use of a less intense antithrombotic regimen in this unique population.

中文翻译：

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老年人左心室辅助装置植入后的临床结果：INTERMACS分析。

目标

这项研究的目的是检查在老年人（> 75岁）中植入左心室辅助装置（LVAD）后的结局。

背景

不断增长的心力衰竭人群以及机械循环支持（MCS）技术的改进已导致老年人的LVAD植入量增加。但是，显示特定年龄结局的数据有限。

方法

机械辅助循环支持机构间注册中心（INTERMACS）中在2008年至2017年之间需要持续MCS的成年患者也包括在内。按4个年龄组对患者进行分层：<55岁，55-64岁和> 75岁。Kaplan-Meier生存估计用于评估LVAD后的结果，对数秩检验用于比较各组。单因素和多因素Cox比例风险回归模型用于确定生存率和并发症的预测因素。

结果

在研究期间，共有20939人接受了LVAD：年龄在55岁以下的有7743人（37.0％），年龄在55至64岁的有6755人（32.3％），年龄在65至74岁的有5418人（25.9％） ，且1,075（4.9％）年龄在75岁或以上。经过多变量调整后，≥75岁的成年人LVAD植入后死亡率增加。老年LVAD患者胃肠道出血的发生率较高，但装置血栓形成的发生率较低。相对于84.5％的<55岁患者出院，而只有46.8％的≥75岁成年人在植入后出院（p <0.001）。RVAD，血清白蛋白水平和6分钟步行测试距离的使用被确定为最老队列结果的预测指标。

结论

尽管为LVAD植入精心选择了老年人，但年龄仍然是死亡率的重要预测指标。老年LVAD患者的较高的出血量和较低的凝血风险支持在这一独特人群中使用强度较小的抗血栓治疗方案。