249 * MINIMALLY INVASIVE LEFT VENTRICULAR ASSIST DEVICE IMPLANTATION IN THE ELDERLY: LOWER MORTALITY AND IMPROVED IN-HOSPITAL OUTCOME

Abstract

Objectives: Cardiac transplantation for elderly patients with terminal heart failure remains restricted by allocation of organs due to donor organ shortage. Nevertheless, demographic changes imply a continuously ageing population that demands alternative therapy options. Thus, left ventricular assist devices (LVADs) are gaining more importance in the treatment of heart failure as destination therapy. However, standard LVAD implantation procedures in this highrisk collective involve surgical complications such as perioperative bleeding and right heart failure with liver impairment. The aim of our study was to assess the outcome of elderly patients receiving an LVAD as destination therapy through a minimally invasive implantation approach. Methods: We reviewed the in-hospital outcome of 38 end-stage heart failure patients (age >60 years) who underwent LVAD implantation (HVAD, HeartWare) in our institution between 2011 and 2012. Patients were divided into two groups according to the implantation procedure: group A (full sternotomy, n = 23), group B (upper hemisternotomy and a left-sided anterolateral thoracotomy, n = 15). Results: Demographic data: 83.3% male, age 65.6 ± 4.6 years; dilated cardiomyopathy 42.6%; ischaemic cardiomyopathy 44.4%. In-hospital mortality was higher in group A (13.0% vs 6.7%). Patients with minimally invasive LVAD implantation had a shorter Intensive Care Unit stay (A, 30.2 ± 12.9 days vs B, 14.9 ± 3.6 days, P < 0.05), a minor bleeding incidence (A, 13.0% vs B, 0%) and lower postoperative bilirubin levels (A, 70.0 ± 16.8 mg/dl vs B, 48.7 ± 3.6 mg/ dl, P < 0.05). Conclusions: Our data show that elderly patients who underwent a minimally invasive LVAD implantation for destination therapy had lower mortality and improved in-hospital outcomes when compared to patients treated by the standard surgical technique.