Impact of frailty on mortality and morbidity in bridge to transplant recipients of contemporary durable mechanical circulatory support

Abstract

Background

: Frailty is associated with adverse outcomes in advanced heart failure. We studied the impact of frailty on post-operative outcomes in bridge to transplant (BTT) durable mechanical circulatory support (MCS) recipients.

Methods

: Patients undergoing left ventricular assist device (LVAD, n=96) or biventricular support (BiV, n=11) as BTT underwent frailty assessment. Frailty was defined as ≥ 3 physical domains of the Fried's Frailty Phenotype (FFP) or ≥ 2 physical domains of the FFP plus cognitive impairment on the Montreal Cognitive Assessment (MoCA).

Results

: No difference in mortality at 360 days was observed in frail (n=6/38, 15.8%) vs non-frail (n=4/58, 6.9%) LVAD supported patients, p=0.19. However, there was a significant excess mortality in frail BiV (n=4/5) vs non-frail BiV (n=0/6) supported patients, p=0.013. In all patients, frail patients compared to non-frail patients experienced longer intensive care unit stay, 12 vs 6 days (p<0.0001) and hospital length of stay, 48 vs 27 days (p<0.0001). There was no difference in hemocompatibility and infection related adverse events. The majority (n=22/29, 75.9%) of frail patients became non-frail following MCS; contrastingly, a minority (n=3/42, 7.1%) became frail from being non-frail (p=0.0003).

Conclusions

: Abnormal markers of frailty are common in patients undergoing BTT-MCS support and those used herein predict mortality in BiV-supported patients, but not in LVAD patients. These findings may help us better identify patients who will benefit most from BiV-BTT therapy.