Which advanced heart failure therapy strategy is optimal for patients over 60 years old?

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Gernhofer, Yan K.University of California, San Diego (author)

Which advanced heart failure therapy strategy is optimal for patients over 60 years old?

Article/chapterEnglish2019

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2019
8 s.

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LIBRIS-ID:oai:lup.lub.lu.se:327b4079-be16-417d-96f7-b2c4099d6127
https://lup.lub.lu.se/record/327b4079-be16-417d-96f7-b2c4099d6127URI
https://doi.org/10.23736/S0021-9509.18.10593-3DOI

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Language:English
Summary in:English

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BACKGROUND: The optimal advanced heart failure (HF) therapy strategy for patients aged 60 or older with end-stage HF refractory to optimal medical therapy remains uncertain. This study compares outcomes of three advanced HF therapy strategies in this patient population. METHODS: A single-center retrospective study was conducted in 95 patients aged 60-73 years who had undergone isolated heart transplantation (HTx) or continuous flow left ventricular assist device (LVAD) implantation from 2010 to 2017. Patients were stratified into three cohorts by strategy; HTx-only (N.=25), LVAD-to-HTx (N.=29), and LVAD-only (N.=41). Primary end point was 2-year overall survival. Secondary end points included incidence of post-operative adverse events, freedom from first readmission at 1 year, and percentage of days spent in hospital following advanced HF therapy. RESULTS: Two-year survival was 91% in HTx-only patients, 88% in LVAD-to-HTx patients, and 49% in LVAD-only patients (P=0.0008). No significant difference in post-transplant survival was found between patients with or without LVAD-related adverse events preceding transplantation (P=0.42). One-year freedom from first readmission was 38.3% in HTx-only patients, 17.2% in LVAD-to-HTx patients and 7.3% in LVAD-only patients (P=0.0028). Patients in LVAD-to-HTx cohort had higher incidences of gastrointestinal bleeding (38% vs. 3%; P<0.01), major bleeding (28% vs. 3%; P=0.02), and right heart failure (69% vs. 31%; P<0.01) during post-LVAD period compared with post-HTx period. Their percentage of days spent in hospital during post-LVAD period was significantly higher than post-HTx period (7.9% vs. 1.2%; P<0.001). CONCLUSIONS: Our experience with patients over 60 years old undergoing advanced therapy suggests that HTx-only and LVAD-to-HTx strategies had superior medium-term survival than LVAD-only strategy. LVAD-to-HTx strategy is effective in reducing incidence of adverse events and percentage of hospitalized days in this specific patient population.

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Braun, Oscar O.Lund University,Lunds universitet,Heart Failure and Mechanical Support,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital(Swepub:lu)kard-oos (author)
Brambatti, MichelaUniversity of California, San Diego (author)
Bui, Quan M.University of California, San Diego (author)
Silva Enciso, JorgeUniversity of California, San Diego (author)
Greenberg, Barry H.University of California, San Diego (author)
Adler, EricUniversity of California, San Diego (author)
Pretorius, VictorUniversity of California, San Diego (author)
University of California, San DiegoHeart Failure and Mechanical Support (creator_code:org_t)

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In:The Journal of cardiovascular surgery60:2, s. 251-2580021-9509

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MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Cardiac and Card ...

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