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Short-term mechanical circulatory support in elderly patients.

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. 43.72%, p=0.403 21) 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 LVEF (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.