British Journal of Surgery · Jul 2026
1324 Impact of Frailty on Clinical Outcomes Following Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis
By Costa C, Rad AA
Abstract Aim Frailty, defined as reduced physiological reserve and increased vulnerability, is common in end-stage heart failure. Continuous-flow left ventricular assist devices (LVADs) improve survival, but the impact of frailty on outcomes is uncertain. This systematic review and meta-analysis assessed the effect of frailty on outcomes following LVAD implantation. Method PubMed, Cochrane, EMBASE, MEDLINE, and Google Scholar were searched to September 2023 in line with PRISMA guidelines. Studies comparing frail and non-frail LVAD recipients were included. Outcomes were pooled using Mantel-Haenszel random-effects models and reported as odds ratios (OR) or mean differences (MD) with 95% confidence intervals (CI). Results Fifteen studies with 3,458 patients were analysed. Frailty was associated with higher long-term mortality (OR 2.12; 95% CI 1.17–3.83; p=0.01) but not short-term mortality (OR 1.61; 95% CI 0.71–3.65; p=0.26). No significant differences were observed in hospital stay (MD 1.93 days; 95% CI −9.83 to 13.68; p=0.75), intubation duration (MD 34.28 hours; 95% CI −1.15 to 69.71; p=0.06), bleeding (OR 1.76; 95% CI 0.76–4.10; p=0.19), infection (OR 0.44; 95% CI 0.11–1.84; p=0.26), or readmission (OR 1.07; 95% CI 0.78–1.46; p=0.68). Conclusions Frailty is linked to increased long-term mortality in LVAD recipients, while short-term outcomes and complication rates appear unaffected. These findings highlight the need for tailored perioperative strategies and further research into frailty-targeted interventions.