Septuagenarians Bridged to Heart Transplantation With a Ventricular Assist Device Have Outcomes Similar to Younger Patients

• Published in: The Annals of thoracic surgery Vol. 95; no. 4; pp. 1251 - 1261
• Main Authors: George, Timothy J., MD, Kilic, Arman, MD, Beaty, Claude A., MD, Conte, John V., MD, Mandal, Kaushik, MBBS, Shah, Ashish S., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-04-2013
• Subjects: Adolescent; Adult; Age Factors; Aged; Cardiothoracic Surgery; Female; Heart Failure - mortality; Heart Failure - therapy; Heart Transplantation - methods; Heart Transplantation - mortality; Heart-Assist Devices; Humans; Male; Middle Aged; Retrospective Studies; Risk Assessment - methods; Surgery; Survival Rate - trends; Time Factors; Tissue Donors - supply & distribution; United States - epidemiology; Young Adult; United States; 34; BTT; United Network for Organ Sharing; 27; CI; orthotopic heart transplantation; mechanical circulatory support; HR; LVAD; ventricular assist device; bridge to transplantation; hazard ratio; VAD; confidence interval; OHT; UNOS; left ventricular assist device; MCS
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.10.089

Background Although orthotopic heart transplantation (OHT) is increasingly being offered to older patients, few studies have evaluated outcomes in patients older than 70 years of age. We undertook this study to characterize the outcomes of septuagenarians bridged to transplantation (BTT) in the modern era. Methods We conducted a retrospective cohort study of all adult OHT in the United Network for Organ Sharing database from 2005 to 2011. Primary stratification was by age 70 years or older. Subgroup analysis evaluated patients who received BTT. The primary outcome was survival as determined by the Kaplan-Meier method. Results From January 2005 to December 2011, 12,274 adults underwent OHT, including 3,243 (26.4%) who received BTT. In the entire cohort, 11,996 (97.7%) recipients were aged 18 to 70 years, and 277 (2.3%) were 70 years of age or older. Overall, patients 70 years or older who underwent OHT had decreased 90-day survival (93.6% versus 88.8%; p < 0.01), 1-year survival (89.0% versus 81.6%; p < 0.01), and 2-year survival (85.4% versus 79.9%; p < 0.01) compared with recipients of other ages. However in the BTT subgroup, recipients 70 years and older (n = 43) had similar 90-day (91.2% versus 84.7%; p = 0.2), 1-year (86.1% versus 81.7%; p = 0.4), and 2-year (82.8% versus 81.7%; p = 0.6) survival compared with recipients of other ages (n = 3,200). After adjusting for multiple recipient and donor factors, age greater than or equal to 70 years was still not associated with an increased hazard of mortality at 90 days, 1 year, or 2 years. These results were verified by analysis of a propensity-matched cohort. Conclusions Although patients older than the age of 70 years undergoing OHT have decreased survival, among patients who received BTT, septuagenarians have outcomes similar to those of younger recipients. In carefully selected patients dependent on left ventricular assist devices (LVADs), recipient age greater than or equal to 70 years should not be viewed as a contraindication to OHT.