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Short-term mechanical circulatory support in elderly patients.
Alonso-Fernandez-Gatta, Marta; Merchan-Gomez, Soraya; Toranzo-Nieto, Ines; Gonzalez-Cebrian, Miryam; Diego-Nieto, Alejandro; Barrio, Alfredo; Martin-Herrero, Francisco; Sanchez, Pedro L.
Afiliación
  • Alonso-Fernandez-Gatta M; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Merchan-Gomez S; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Toranzo-Nieto I; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Gonzalez-Cebrian M; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Diego-Nieto A; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Barrio A; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Martin-Herrero F; Cardiology Department, University Hospital of Salamanca, IBSAL, Salamanca, Spain.
  • Sanchez PL; CIBER-CV Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
Artif Organs ; 46(5): 867-877, 2022 May.
Article en En | MEDLINE | ID: mdl-34780090
BACKGROUND: Age over 70 years seems to confer poor prognosis for patients under mechanical circulatory support (MCS). Advanced age is usually a relative contraindication. Our objective was to assess the impact of age on survival of patients with short-term MCS. METHODS: Retrospective analysis of ≥70-year-old patients supported with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) or Impella CP® due to cardiogenic shock and other situations of hemodynamic instability in a referral hospital (elderly group), compared with younger patients (<70 years). We analyze factors associated with survival in elderly group. RESULTS: Out of 164 short-term MCS implants from 2013 to October 2020, 45 (27.4%) correspond to ≥70-year-old patients (73.3% VA-ECMO; 26.7% Impella CP®), 80% as bridge to recovery and 15.6% for high-risk percutaneous coronary intervention (PCI). We found no significant differences in complications developed between both groups. Survivals at discharge (40% vs. 43.7%, p = 0.403) and at follow-up (median 13.6 [30] months) were similar in elderly and young patients (35.6% vs. 37.8%, log-rank p = 0.061). Predictive factors of mortality in elderly patients were peripheral artery disease (p = 0.037), higher lactate (p = 0.003) and creatinine (p = 0.035) at implant, longer cardiac arrest (p = 0.003), and worse post-implantation left ventricular ejection fraction (p = 0.003). Patients with indication of MCS for high-risk PCI had higher survival compared to other indications (p = 0.013). CONCLUSION: Short-term MCS with VA-ECMO or Impella CP® in elderly patients may be a reasonable option in hemodynamic compromise situations as bridge to recovery or elective high-risk PCI, without a significant increase in complications or mortality. Age should not be an absolute contraindication, but careful selection of candidate patients is necessary.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Corazón Auxiliar / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies Límite: Aged / Humans Idioma: En Revista: Artif Organs Año: 2022 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Corazón Auxiliar / Intervención Coronaria Percutánea Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies Límite: Aged / Humans Idioma: En Revista: Artif Organs Año: 2022 Tipo del documento: Article País de afiliación: España Pais de publicación: Estados Unidos