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Which advanced hear...
Which advanced heart failure therapy strategy is optimal for patients over 60 years old?
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- Gernhofer, Yan K. (author)
- University of California, San Diego
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- Braun, Oscar O. (author)
- Lund University,Lunds universitet,Heart Failure and Mechanical Support,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital
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- Brambatti, Michela (author)
- University of California, San Diego
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- Bui, Quan M. (author)
- University of California, San Diego
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- Silva Enciso, Jorge (author)
- University of California, San Diego
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- Greenberg, Barry H. (author)
- University of California, San Diego
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- Adler, Eric (author)
- University of California, San Diego
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- Pretorius, Victor (author)
- University of California, San Diego
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(creator_code:org_t)
- 2019
- 2019
- English 8 s.
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In: The Journal of cardiovascular surgery. - 0021-9509. ; 60:2, s. 251-258
- Related links:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.2...
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Abstract
Subject headings
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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.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Publication and Content Type
- art (subject category)
- ref (subject category)
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