Artificial heart as destination therapy for elderly patients with terminal heart failure

Background: Patients over 65 years old who are diagnosed with terminal heart failure are often not considered for heart transplantation due to the expected perioperative risks of the procedure and the current lack of available organs. Implantation of an “off the shelf” links ventricular assist device (LVAD) is an attractive alternative to transplantation. This applies especially to patients who do not fulfill the transplantation requirements. Nowadays, the number of LVADs implanted per year worldwide is higher than the number of cardiac transplantations and the number of patients who receive LVADs as destination therapy is continuously increasing. However, the implantation of an assist device in older patients is a challenge due to the higher level of comorbidities and risk factors. Furthermore, compliance and social criteria, e. g. family situation, have to be diligently taken into consideration before the procedure. Material and methods: This article reviews the outcome of LVAD implantation in the elderly. A systematic review of the literature was carried out using the Medline database and the search terms “left ventricular assist device”, “LVAD”, “elderly”, “outcome” and “adverse events”. Results and conclusion: The investigation showed that the outcomes of patients over the age of 65 years are comparable to those of younger patients where accurate follow-up and outpatient care are the key to a successful destination therapy in the older age group. © 2015, Springer-Verlag Berlin Heidelberg.