Outcomes of orthotopic heart transplantation and left ventricular assist device in patients aged 65 years or more with end-stage heart failure.
Outcomes of orthotopic heart transplantation and left ventricular assist device in patients aged 65 years or more with end-stage heart failure.
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DOI：
10.1080/08998280.2019.1576095
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发表时间：
2019-04-01
期刊：
影响因子：
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通讯作者：
Hall, Shelley A
中科院分区：
文献类型：
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作者：
Harmon, David M;Tecson, Kristen M;Hall, Shelley A
年龄传统上是晚期心力衰竭（HF）治疗的限制因素。原位心脏移植（OHT）年龄指南的限制已变得较少，左心室辅助装置（LVAD）越来越多地用作≥65岁患者的目标治疗。尽管适应症不同，我们评估了这两种方式在老年人群中的结果。我们回顾了2012年至2016年在我中心接受≥65岁连续晚期HF治疗的患者的图表。在评价的118例患者中，46例（39%）接受了LVAD，72例（61%）接受了OHT。两组之间的性别、体重指数和既往胸骨切开术的发生率相似; OHT接受者更年轻，不太可能患有糖尿病，更可能因缺血性病因而患有HF。46%的接受LVAD的患者是紧急需要（机械辅助循环支持机构间登记[INTERMACS]概况1-2），而接受OHT的患者为29%（器官共享联合网络1A标准; P=0.068）。与LVAD接受者相比，OHT接受者的住院时间更短，1年生存率更高。尽管许多中心不为≥65岁的患者提供晚期HF治疗，但我们的结果表明，年龄本身不应成为晚期HF治疗的障碍，尤其是OHT。
Age has traditionally been a limiting factor for advanced heart failure (HF) therapies. Orthotopic heart transplantation (OHT) age guidelines have become less restrictive, and left ventricular assist devices (LVADs) are increasingly utilized as destination therapy for patients ≥65 years. Although indications differ, we assessed outcomes for both modalities in this older population. We reviewed charts of consecutive advanced HF therapy recipients aged ≥65 years at our center from 2012 to 2016. Of 118 patients evaluated, 46 (39%) received an LVAD and 72 (61%) received OHT. Gender, body mass index, and rate of prior sternotomy were similar between groups; OHT recipients were younger, less likely to have diabetes mellitus, and more likely to have HF due to ischemic etiology. Forty-six percent of patients receiving LVADs were urgent need (Interagency Registry for Mechanically Assisted Circulatory Support [INTERMACS] profile 1-2), compared to 29% of patients receiving OHT (United Network for Organ Sharing 1A criteria; P=0.068). OHT recipients had shorter lengths of stay and better 1-year survival compared to LVAD recipients. Although many centers do not offer advanced HF therapy to patients aged ≥65 years, our results indicate that age alone should not be prohibitive for advanced HF therapy, particularly OHT.