Introduction: The incidence of end-stage heart failure increases proportionally with advancing average lifespan in the elderly population. Due to the limited number of donors in this patient group, the possibility of heart transplantation poses a more serious challenge compared to other age groups. The aim of this study is to compare the morbidity and mortality of ventricular assist devices used for destination therapy in patients aged 65 and over with other patient groups.
Materials and Methods: A total of 98 patients who underwent left ventricular assist device implantation as destination therapy in our clinic between April 2012 and December 2023 were retrospectively reviewed. After applying exclusion criteria, 64 patients were included in the study. Patients were grouped according to age; 12 patients (study group) aged 65 and over (10 HeartWare, 2 HeartMate III), and 42 patients in the 50-64 age group (control group) (38 HeartWare, 2 HeartMate II, 2 HeartMate III) were included in the study. Preoperative echocardiography parameters, cardiac catheterization parameters, blood parameters, and demographic characteristics of the patients, as well as postoperative echocardiography parameters, daily biochemical blood parameters, urine outputs, medical treatments used, stroke, driveline infection, gastrointestinal complications, development of right heart failure, kidney injury, mortality rates over the years, and monthly follow-up were recorded from the Başkent University database.
Results: In the control group, SVO (Cerebrovascular event) occurred in 23 out of 42 patients (55%), while in the study group, SVO occurred in 3 out of 12 patients (25%). Device thrombosis was observed in 12 patients (29%) in the control group and in 1 patient (8.3%) in the study group. Driveline infection developed in 20 patients (48%) in the control group and in 4 patients (25%) in the study group. The one-year mortality rate was 14% (6 patients) in the control group and 8.3% (1 patient) in the study group.
Conclusion: In some clinical settings and publications, advanced age (>70 years) is considered a relative contraindication for heart transplantation, and priority is given to younger patients for transplantation, leaving these patients without medical treatment alternatives. Therefore, we consider ventricular assist devices as an alternative to medical treatment in eligible patients with end-stage heart failure.