Work

The interaction of age and time on durable left ventricular assist device and its effect on heart transplant outcomes

Year: 2026

Type: article

Abstract: Objective This study aims to assess interaction between age and left ventricular assist device (LVAD) duration on heart transplant (HT) outcomes in the modern era. Methods All HT in adults with a fully magnetically levitated centrifugal flow LVAD between October 2018- June 2025 were identified from UNOS database. Groups were stratified primarily by <55 and ≥55 years of age and secondarily by <2 and ≥2 years of LVAD support. The primary outcome was post-HT survival. Results 1005 patients were <55 years with 608 having LVAD <2 years and 397 ≥2 years. There was no significant difference in post-HT survival between LVAD duration groups at 90 days (95.3% vs 94.4 %, p=0.57), 1 year (93.7% vs 90.2%, p=0.07), or 3 years (88.0% vs 83.9%, p=0.061). 1411 patients were ≥55 years with 935 having LVAD <2 years and 476 ≥2 years. LVAD <2 years exhibited improved survival at 90 days [92.4% vs 89.2%, p=0.046], 1 year [87.8% vs 81.9%, p=0.0051], and 3 years [81.4% vs 72.7%, p=0.0011]. Multivariable adjustment showed a significant impact of age ≥55 on post-HT mortality [HR 1.96 (95% CI 1.34-2.86), p <0.001]; LVAD ≥2 years, however, showed no significant impact [HR 1.47 (95% CI 0.91-2.36), p 0.116]. Formal testing revealed no significant interaction of age and LVAD duration [HR of 1.1 (95% CI 0.63-1.91), p 0.735]. Conclusions Although there is a lower observed post-HT survival in patients ≥ 55 years and supported by LVAD ≥ 2 years, formal testing reveals no significant interaction of these variables on mortality.

Source: JTCVS Open

DOI: 10.1016/j.xjon.2026.102068