Effects of Age and Comorbidities on Intensive Care and 1-year Mortality after HeartMate 3 Implantation

Background: The use of left ventricular assist devices (LVAD) has been rapidly increasing in older people over the past two decades due to their availability as destination therapy. This study aimed to assess the effect of age and comorbidities on the intensive care unit (ICU) and 1-year mortality after HeartMate 3 LVAD implantation.Methods: From 2016 to 2023, all consecutive adult patients implanted with HeartMate 3 LVAD in our tertiary referral center were enrolled in the study. Patients were stratified according to their age at implantation into Group-1 (< 45 years), Group-2 (46-64 years), and Group-3 (> 65 years). The effect of age and comorbidities on ICU and 1-year mortality were assessed.Results: In total, 135 patients were included (mean age 54 +/- 13 years, 79% males). Baseline vital signs, comorbidities, and hemodynamic support were not different between age groups. The older population had significantly lower eGFR (p=0.025), ischemic cardiac diseases as the underlying heart problem (p<0.001), and LVAD as destination therapy (p<0.001). The mortality rate at the ICU and at one year were 90% and 83%, respectively. The median age of the patients who died in the ICU was significantly higher than 63 [56-65] years versus 57 years [49-62, p=0.034). However, age lost its significance with logistic regression analysis. Having a recent major myocardial infarct, high preoperative leukocyte count, and cardiopulmonary bypass time were independent risk factors for ICU mortality. On the other hand, age was an independent risk factor for one-year mortality.Conclusion: Older age predicts increased one-year but not ICU mortality after HeartMate 3 LVAD implantation, while recent major myocardial infarction, high preoperative leukocyte count, and longer cardiopulmonary bypass time were independent risk factors for ICU mortality. Careful patient selection is critical to optimize outcomes after HeartMate 3 LVAD implantation.