HM3 LVAD support in patients over 65 years: a multicenter experience
L Botta, A Loforte, A Francica, R Abete, A Selimi, D Piani, L Cavallotti, F Onorati, F Gazzoli, I Vendramin, F M Righini, A Terzi, G B Luciani, M Rinaldi, D PaciniAbstract
Abstract
Background: Contemporary Left ventricular assist devices (LVADs) have improved outcomes in patients with advanced heart failure. Nevertheless, longevity, progress in medical therapies and a still reduced awareness about durable mechanical circulatory supports (dMCS) may determine a delayed referral of patients, sometimes evaluated for LVAD implantation in older age.
Purpose
We reviewed our multicenter experience to evalute outcomes of HM3 in patients with an age of 65 years or more.
Methods
Seven centers reported their experience with HM3 LVAD implantation from 2016 to 2025. Out of 674 patients receiving a dMCS, 336 were HM3 (297 males, mean age 59.2y). Of these, 120 (Group A, 104 males) were implanted in patients with an age equal/greater than 65 years. Ischemic or idiopathic CMP was present in 69 and 45 pts in group A vs. 105 and 101 pts in group B (p:NS). In Group A, 24 pts were in INTERMACS Class I-II and 94 in Class III -IV (vs 68 and 145 in group B, p=0,024 and 0,030). In group A, 22 pts had IABP vs. 70 of group B (p:0,06) while 5 were under VA-ECMO vs. 15 (p:NS). HM3 was implanted as BTT, BTC and DT in 10, 6 and 104 patients in group A (vs. 124, 55, 37 patients in group B, p<0,001). Mean LV EF was comparable between the groups (20.9 vs. 21.3%).
Results
More than 70% of cases older than 65 have been performed in the last 5 years (fig. 1). Associated procedures were performed in 35 cases (29.2%) of group A vs. 36 of group B (16.6%), p=0,007, with 11 vs. 8 left appendage closures, 8 vs. 9 aortic valve replacements, respectively. Twelve pts required a temporary RVAD in group A vs. 18 of group B (P=0.6). Need for blood transfusions was high in both groups (90% vs. 85.9%) with similar ICU stay (17 days). Thirty-one patients needed CVVH in group A vs. 55 of group B (p:NS). There were 21 rethoracotomy for bleeding vs. 44 (p:NS). In -hospital mortality was 19.2% vs. 12% (p=0,076). Twelve, 24 and 60 months survival was 82.6, 63.5 and 24% in group A vs. 94.9, 85.5 and 64.5% in group B (log-rank < 0,001). At FU, 2 pts underwent HTX in group A vs. 52 in group B, p<0,001. Sixty-six pts were re-admitted for any cause (group A) vs. 121 group B; 37 (A) vs. 90 (B) had a driveline infection while pump thrombosis was observed in 1 (A, 0.8%) and 3 (B, 1.4%) patients. Freedom from any stroke and gastro-intestinal bleeding at 1,2 and 5 years were respectively 86.7, 79.2, 60.3 (A) vs. 89.7, 89.7, 78.6 (B), log-rank=0,028 and 89.3, 85,5, 73.3% (A) vs. 92.6, 91, 82.9% (B), log-rank 0.219 (fig. 2).
Conclusions
The number of elederly patients requiring LVAD support is increasing over the last 5 years, requiring an higher incidence of associated procedures. In-hospital and FU outcomes are satisfactory although worse than those of patients with less than 65 years, with lower survival and access to heart transplant at FU and higher rates of stroke. HM3 confirms to be a reliable device even in the elderly, although requiring a strict patients’ selection.Yearly distribution HM3 over 65yFor image description, please refer to the figure legend and surrounding text.Survival curves HM3 over 65For image description, please refer to the figure legend and surrounding text.