Survival in Elderly Patients Supported With Continuous Flow Left Ventricular Assist Device as Bridge to Transplantation or Destination Therapy ANDREW N. ROSENBAUM, MD, 1 RANJIT JOHN, MD, 2 KENNETH K. LIAO, MD, 2 SIRTAZ ADATYA, MD, 1 MONICA M. COLVIN-ADAMS, MD, 1 MARC PRITZKER, MD, 1 AND PETER M. ECKMAN, MD 1 Minneapolis, Minnesota ABSTRACT Background: Published data on mechanical circulatory support for elderly patients in continuous flow devices are sparse and suggest relatively poor survival. This study investigated whether LVADs can be implanted in selected patients over the age of 65 years with acceptable survival compared with published outcomes. Methods and Results: A single-center retrospective analysis was conducted in 64 consecutive patients $65 years of age implanted with a continuous-flow left ventricular assist device (CF-LVAD) as either bridge to transplantation or destination therapy from August 2005 to January 2012. Baseline laboratory and hemodynamic characteristics and follow-up data were obtained. Median survival was 1,090 days. Sur- vival was 85%, 74%, 55%, and 45% at 6 months and 1, 2, and 3 years, respectively. Our cohort had a baseline mean Seattle Heart Failure Model (SHFM) score of 2.6 6 0.9. Observed survival was signifi- cantly better than SHFM-predicted medical survival. Stratification by age subsets, renal function, SHFM, implantation intention, or etiology did not reveal significant differences in survival. The most com- mon cause of death was sepsis and nonlethalcomplication was bleeding. Conclusions: Our experience with patients over the age of 65 receiving CF-LVADs suggests that this group demonstrates excellent survival. Further research is needed to discern the specific criteria for risk stratification for LVAD support in the elderly. (J Cardiac Fail 2014;20:161e167) Key Words: Survival, elderly, LVAD, destination therapy. Patient selection in the realm of mechanical circulatory support (MCS) for end-stage heart failure has been a topic of recent discussion that has coincided with the advent of sig- nificant data showing improved outcomes compared with medical management. 1 Development of second- and third- generation continuous-flow (CF) devices has strengthened this trend toward implantation for both destination therapy (DT) and bridge to transplantation therapy (BTT). 2e5 Although some studies have shown that there is little difference in physiologic parameters that result from pulsatile-flow or CF devices, more recent data have shown that second-generation CF left ventricular assist devices (LVADs) are associated with greater survival, fewer pump failures, increased functional capacity, and better quality of life than first-generation pulsatile-flow devices. 6e8 It remains unclear whether the superior out- comes with nonpulsatile pumps can be attributed to flow characteristics, decreased morbidity of the implant candi- date, or pump size. Because advanced age is a relative contraindication for cardiac transplantation, outcomes in patients being consid- ered for LVAD therapy are anticipated to be of particular importance, especially as age of presentation of advanced heart failure increases. 9 Although age has been shown to be associated with worse prognosis in all MCS 10 and even in CF-LVAD, 11 these effects were not necessarily in- dependent of renal impairment and other comorbidities. Also, advanced age tends to be associated with an increased prevalence of ischemic cardiomyopathy, 12,13 which may From the 1 Cardiovascular Division, Department of Medicine, University of Minnesota, Minneapolis, Minnesota and 2 Division of Cardiothoracic Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota. Manuscript received June 4, 2013; revised manuscript received December 11, 2013; revised manuscript accepted December 18, 2013. Reprint requests: Peter M. Eckman, MD, Cardiovascular Division, Department of Medicine, University of Minnesota. Minneapolis, MN 55455. Tel: þ1 6126257924; Fax: þ1 6126264411. E-mail: eckmanp@ umn.edu All decisions regarding this manuscript were made by a guest editor. See page 166 for disclosure information. 1071-9164/$ - see front matter Published by Elsevier Inc. http://dx.doi.org/10.1016/j.cardfail.2013.12.015 161 Journal of Cardiac Failure Vol. 20 No. 3 2014