Clinical Strategies and Outcomes in Advanced Heart Failure Patients Older Than 70 Years of Age Receiving the HeartMate II Left Ventricular Assist Device A Community Hospital Experience

Objectives The primary objective of this study was to determine outcomes in left ventricular assist device (LVAD) patients older than age 70 years. Background Food and Drug Administration approval of the HeartMate II (Thoratec Corporation, Pleasanton, California) LVAD for destination therapy has provided an attractive option for older patients with advanced heart failure. Methods Fifty-five patients received the HeartMate II LVAD between October 5, 2005, and January 1, 2010, as part of either the bridge to transplantation or destination therapy trials at a community hospital. Patients were divided into 2 age groups: > 70 years of age (n = 30) and < 70 years of age (n = 25). Outcome measures including survival, length of hospital stay, adverse events, and quality of life were compared between the 2 groups. Results Pre-operatively, all patients were in New York Heart Association functional class IV refractory to maximal medical therapy. Kaplan-Meier survival for patients > 70 years of age (97% at 1 month, 75% at 1 year, and 70% at 2 years) was not statistically different from patients < 70 years of age (96% 1 month, 72% at 1 year, and 65% at 2 years, p = 0.806). Average length of hospital stay for the >= 70-year age group was 24 +/- 15 days, similar to that of the < 70-year age group (23 +/- 14 days, p = 0.805). There were no differences in the incidence of adverse events between the 2 groups. Quality of life and functional status improved significantly in both groups. Conclusions The LVAD patients >= 70 years of age have good functional recovery, survival, and quality of life at 2 years. Advanced age should not be used as an independent contraindication when selecting a patient for LVAD therapy at experienced centers. (J Am Coll Cardiol 2011;57:2487-95) (C) 2011 by the American College of Cardiology Foundation