1. Do Older LVAD Patients Have Compromised Outcome after Heart Transplantation: Should They Stay as Destination Therapy?
- Author
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Kittleson, M., Patel, J., Moriguchi, J., Cole, R., Singer-Englar, T., Patel, N., Runyan, C., Welton, M., Czer, L., Catarino, P., and Kobashigawa, J.
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ARTIFICIAL implants , *IMPLANTABLE cardioverter-defibrillators , *OLDER patients , *HEART transplantation , *GRAFT rejection , *HEART assist devices , *PERCUTANEOUS coronary intervention - Abstract
In many heart transplant (HTx) programs, patients greater than 65 years of age who have had a previous left ventricular assist device (LVAD) are not candidates for HTX. They are kept at destination therapy. It is believed that these patients will have complications if transplanted. It has not been well established as to the outcome of these older LVAD patients undergoing HTx. Between 2010 and 2021, we assessed 35 patients who underwent a previous LVAD placement and subsequently underwent HTx at ≥65 years of age (range 65 to 70). A control group was comprised of patients (≥65 years) who underwent HTx without LVAD support. Post-transplant outcomes included 30-day and 1-year survival as well as 1-year freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), cardiac allograft vasculopathy (CAV: stenosis ≥30%), acute cellular rejection (ACR), and antibody-mediated rejection (AMR). LVAD patients who underwent HTx at the age ≥65 years appear to have comparable outcomes compared to patients who underwent HTx without LVAD support ≥65 years. 1-year survival, freedom from NF-MACE, CAV, ACR, AMR were not significantly different. Older patients (≥65years) supported on an LVAD do not have compromised post-HTx outomes. These patients do not necessarily need to be committed to destination therapy. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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