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

Gernhofer, Yan K. ; Braun, Oscar O. LU ; Brambatti, Michela ; Bui, Quan M. ; Silva Enciso, Jorge ; Greenberg, Barry H. ; Adler, Eric and Pretorius, Victor (2019) In The Journal of cardiovascular surgery 60(2). p.251-258
Abstract

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,... (More)

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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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Journal of cardiovascular surgery
volume
60
issue
2
pages
8 pages
publisher
Edizioni Minerva Medica
external identifiers
  • scopus:85061965744
  • pmid:30168306
ISSN
0021-9509
DOI
10.23736/S0021-9509.18.10593-3
language
English
LU publication?
yes
id
327b4079-be16-417d-96f7-b2c4099d6127
date added to LUP
2019-03-05 14:37:18
date last changed
2020-04-08 16:51:27
@article{327b4079-be16-417d-96f7-b2c4099d6127,
  abstract     = {<p>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&lt;0.01), major bleeding (28% vs. 3%; P=0.02), and right heart failure (69% vs. 31%; P&lt;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&lt;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.</p>},
  author       = {Gernhofer, Yan K. and Braun, Oscar O. and Brambatti, Michela and Bui, Quan M. and Silva Enciso, Jorge and Greenberg, Barry H. and Adler, Eric and Pretorius, Victor},
  issn         = {0021-9509},
  language     = {eng},
  number       = {2},
  pages        = {251--258},
  publisher    = {Edizioni Minerva Medica},
  series       = {The Journal of cardiovascular surgery},
  title        = {Which advanced heart failure therapy strategy is optimal for patients over 60 years old?},
  url          = {http://dx.doi.org/10.23736/S0021-9509.18.10593-3},
  doi          = {10.23736/S0021-9509.18.10593-3},
  volume       = {60},
  year         = {2019},
}