Significance of Destination Therapy Using Implantable Left Ventricular Assist Devices in Elderly Patients with Severe Heart Failure

Objectives: Elderly patients with heart failure (HF) requiring left ventricular assist device (LVAD) have increased. Destination therapy (DT) with implantable LVADs (iLVADs) for HF has more important roles because of shortage of donor hearts and age limitation of iLVADs in Japan (according to indication of HTx). The elderly patients (>65 yo) requiring LVADs have difficulties caused by extracorporeal LVADs (eLVADs). Patients and Methods: We investigated postoperative complications (MACCE) in 9 eLVAD patients (age: 46.7 ± 12.6 yo) from 2006 through 2015 in our hospital. eLVAD was applied for ischemic cardiomyopathy in 3, dilated cardiomyopathy in 4, peripartum cardiomyopathy in 1 and eosinophilic cardiomyopathy in 1. Results: One patient (36-year-old female) with eLVAD for dilated cardiomyopathy underwent HTx and one patient (32-year-old female) with peripartum cardiomyopathy weaned eLVAD. The other 7 patients (2 patients aged > 65) died during hospitalzation due to sepsis, cerebral bleeding/infarction, or multiple organ failure on POD 595 ± 711. Conclusion: The postoperative complications in patients undergoing LVADs are important factors determining patient's prognoses. Especially sepsis is a major factor of mortality in the long-term period after eLVADs. DT therapy using iLVADs in elderly patients with severe HF is inevitable for avoiding serious complications including sepsis and for achieving longer survival and better QOL.