Comparison of outcomes after heart replacement therapy in patients over 65 years old

Robert A. Sorabella, Halit Yerebakan, Ryan Walters, Koji Takeda, Paolo Colombo, Melana Yuzefpolskaya, Ulrich P. Jorde, Donna Mancini, Hiroo Takayama, Yoshifumi Naka

Research output: Contribution to journalArticle

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Abstract

Background There are currently no well-defined, evidence-based guidelines for management of end-stage heart failure in patients over 65, and the decisions to use mechanical circulatory support with left ventricular assist device (LVAD), either as a bridge to transplantation or destination therapy, or isolated heart transplantation (HTx) remain controversial. We aimed to compare the outcomes after the implementation of three heart replacement strategies in this high-risk population. Methods We conducted a retrospective cohort study of all patients between the ages of 65 and 72 receiving a continuous-flow LVAD as bridge to transplantation or destination therapy or isolated HTx at our center between 2005 and 2012. The patients were stratified according to treatment strategy into three groups: group D (destination LVAD, n = 23), group B (bridge to transplantation LVAD, n = 43), and group H (HTx alone, n = 47). The primary outcomes of interest were survival to discharge and 2-year overall survival. Results The patients in group D were significantly older, had a higher prevalence of ischemic cardiomyopathy, and had a higher pulmonary vascular resistance than did patients in groups B or H. There were no significant differences between groups in survival to discharge (87% D vs 83.7% B vs 87.2% H, p = 0.88) or 2-year overall survival (75.7% D vs 68.7% B vs 80.9% H, log-rank p = 0.47). The incidence rates of readmission were 1.1 events/patient·year in group D and 0.5 events/patient·year in group H. Conclusions There was no significant difference in perioperative, short-term, and medium-term survival between the treatment groups. However, the LVAD patients had a higher incidence of readmission. Larger trials are needed to refine differences in long-term survival, quality of life, and resource utilization for elderly patients requiring heart replacement therapy.

Original languageEnglish (US)
Pages (from-to)582-588
Number of pages7
JournalAnnals of Thoracic Surgery
Volume99
Issue number2
DOIs
StatePublished - Feb 1 2015
Externally publishedYes

Fingerprint

Heart-Assist Devices
Survival
Transplantation
Therapeutics
Incidence
Heart Transplantation
Cardiomyopathies
Vascular Resistance
Cohort Studies
Heart Failure
Retrospective Studies
Quality of Life
Guidelines
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Sorabella, R. A., Yerebakan, H., Walters, R., Takeda, K., Colombo, P., Yuzefpolskaya, M., ... Naka, Y. (2015). Comparison of outcomes after heart replacement therapy in patients over 65 years old. Annals of Thoracic Surgery, 99(2), 582-588. https://doi.org/10.1016/j.athoracsur.2014.08.044

Comparison of outcomes after heart replacement therapy in patients over 65 years old. / Sorabella, Robert A.; Yerebakan, Halit; Walters, Ryan; Takeda, Koji; Colombo, Paolo; Yuzefpolskaya, Melana; Jorde, Ulrich P.; Mancini, Donna; Takayama, Hiroo; Naka, Yoshifumi.

In: Annals of Thoracic Surgery, Vol. 99, No. 2, 01.02.2015, p. 582-588.

Research output: Contribution to journalArticle

Sorabella, RA, Yerebakan, H, Walters, R, Takeda, K, Colombo, P, Yuzefpolskaya, M, Jorde, UP, Mancini, D, Takayama, H & Naka, Y 2015, 'Comparison of outcomes after heart replacement therapy in patients over 65 years old', Annals of Thoracic Surgery, vol. 99, no. 2, pp. 582-588. https://doi.org/10.1016/j.athoracsur.2014.08.044
Sorabella RA, Yerebakan H, Walters R, Takeda K, Colombo P, Yuzefpolskaya M et al. Comparison of outcomes after heart replacement therapy in patients over 65 years old. Annals of Thoracic Surgery. 2015 Feb 1;99(2):582-588. https://doi.org/10.1016/j.athoracsur.2014.08.044
Sorabella, Robert A. ; Yerebakan, Halit ; Walters, Ryan ; Takeda, Koji ; Colombo, Paolo ; Yuzefpolskaya, Melana ; Jorde, Ulrich P. ; Mancini, Donna ; Takayama, Hiroo ; Naka, Yoshifumi. / Comparison of outcomes after heart replacement therapy in patients over 65 years old. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 2. pp. 582-588.
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abstract = "Background There are currently no well-defined, evidence-based guidelines for management of end-stage heart failure in patients over 65, and the decisions to use mechanical circulatory support with left ventricular assist device (LVAD), either as a bridge to transplantation or destination therapy, or isolated heart transplantation (HTx) remain controversial. We aimed to compare the outcomes after the implementation of three heart replacement strategies in this high-risk population. Methods We conducted a retrospective cohort study of all patients between the ages of 65 and 72 receiving a continuous-flow LVAD as bridge to transplantation or destination therapy or isolated HTx at our center between 2005 and 2012. The patients were stratified according to treatment strategy into three groups: group D (destination LVAD, n = 23), group B (bridge to transplantation LVAD, n = 43), and group H (HTx alone, n = 47). The primary outcomes of interest were survival to discharge and 2-year overall survival. Results The patients in group D were significantly older, had a higher prevalence of ischemic cardiomyopathy, and had a higher pulmonary vascular resistance than did patients in groups B or H. There were no significant differences between groups in survival to discharge (87{\%} D vs 83.7{\%} B vs 87.2{\%} H, p = 0.88) or 2-year overall survival (75.7{\%} D vs 68.7{\%} B vs 80.9{\%} H, log-rank p = 0.47). The incidence rates of readmission were 1.1 events/patient·year in group D and 0.5 events/patient·year in group H. Conclusions There was no significant difference in perioperative, short-term, and medium-term survival between the treatment groups. However, the LVAD patients had a higher incidence of readmission. Larger trials are needed to refine differences in long-term survival, quality of life, and resource utilization for elderly patients requiring heart replacement therapy.",
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AU - Sorabella, Robert A.

AU - Yerebakan, Halit

AU - Walters, Ryan

AU - Takeda, Koji

AU - Colombo, Paolo

AU - Yuzefpolskaya, Melana

AU - Jorde, Ulrich P.

AU - Mancini, Donna

AU - Takayama, Hiroo

AU - Naka, Yoshifumi

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N2 - Background There are currently no well-defined, evidence-based guidelines for management of end-stage heart failure in patients over 65, and the decisions to use mechanical circulatory support with left ventricular assist device (LVAD), either as a bridge to transplantation or destination therapy, or isolated heart transplantation (HTx) remain controversial. We aimed to compare the outcomes after the implementation of three heart replacement strategies in this high-risk population. Methods We conducted a retrospective cohort study of all patients between the ages of 65 and 72 receiving a continuous-flow LVAD as bridge to transplantation or destination therapy or isolated HTx at our center between 2005 and 2012. The patients were stratified according to treatment strategy into three groups: group D (destination LVAD, n = 23), group B (bridge to transplantation LVAD, n = 43), and group H (HTx alone, n = 47). The primary outcomes of interest were survival to discharge and 2-year overall survival. Results The patients in group D were significantly older, had a higher prevalence of ischemic cardiomyopathy, and had a higher pulmonary vascular resistance than did patients in groups B or H. There were no significant differences between groups in survival to discharge (87% D vs 83.7% B vs 87.2% H, p = 0.88) or 2-year overall survival (75.7% D vs 68.7% B vs 80.9% H, log-rank p = 0.47). The incidence rates of readmission were 1.1 events/patient·year in group D and 0.5 events/patient·year in group H. Conclusions There was no significant difference in perioperative, short-term, and medium-term survival between the treatment groups. However, the LVAD patients had a higher incidence of readmission. Larger trials are needed to refine differences in long-term survival, quality of life, and resource utilization for elderly patients requiring heart replacement therapy.

AB - Background There are currently no well-defined, evidence-based guidelines for management of end-stage heart failure in patients over 65, and the decisions to use mechanical circulatory support with left ventricular assist device (LVAD), either as a bridge to transplantation or destination therapy, or isolated heart transplantation (HTx) remain controversial. We aimed to compare the outcomes after the implementation of three heart replacement strategies in this high-risk population. Methods We conducted a retrospective cohort study of all patients between the ages of 65 and 72 receiving a continuous-flow LVAD as bridge to transplantation or destination therapy or isolated HTx at our center between 2005 and 2012. The patients were stratified according to treatment strategy into three groups: group D (destination LVAD, n = 23), group B (bridge to transplantation LVAD, n = 43), and group H (HTx alone, n = 47). The primary outcomes of interest were survival to discharge and 2-year overall survival. Results The patients in group D were significantly older, had a higher prevalence of ischemic cardiomyopathy, and had a higher pulmonary vascular resistance than did patients in groups B or H. There were no significant differences between groups in survival to discharge (87% D vs 83.7% B vs 87.2% H, p = 0.88) or 2-year overall survival (75.7% D vs 68.7% B vs 80.9% H, log-rank p = 0.47). The incidence rates of readmission were 1.1 events/patient·year in group D and 0.5 events/patient·year in group H. Conclusions There was no significant difference in perioperative, short-term, and medium-term survival between the treatment groups. However, the LVAD patients had a higher incidence of readmission. Larger trials are needed to refine differences in long-term survival, quality of life, and resource utilization for elderly patients requiring heart replacement therapy.

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