Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
J Heart Lung Transplant. 2010 Jan;29(1):61-5. doi: 10.1016/j.healun.2009.10.008.
Advanced age is considered a relative contraindication to heart transplantation, but there is no published consensus on critical age in the case of mechanical circulatory support (MCS). This single-center study investigated outcomes of elective versus emergent implementation of permanent MCS in the elderly.
Between January 1, 2006 and April 1, 2009, 31 patients, >65 years of age, were supported with a ventricular assist device (VAD), intended for permanent support, at our institution. The 28 left VAD (LVAD) recipients were divided into two groups: a survival group, n = 13 (ongoing MCS at 180 days or weaned); and a non-survival group, n = 15 (death on device within 180 days). In addition, the survival rate of LVAD recipients according to pre-operative INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) status was analyzed.
The cumulative survival rates for the LVAD patients were 75% at 30 days, 46% at 180 days and 39% at 1 year after VAD implantation. The cumulative survival rates at 30 days, 180 days and 1 year were 71%, 47% and 35% for INTERMACS Level I to III (n = 17) patients vs 81%, 45% and 45% for INTERMACS Level IV to V (n = 11) patients (p = 0.9), respectively. Median age of LVAD recipients was 69 (range 66 to 80) years; 4 were women. Median support time was 565 (range 228 to 1,257) days. In 9 recipients support is ongoing. Both complications profiles and causes of death are reported.
Our experience indicates that permanent MCS may be successful in highly selected elderly patients with terminal heart failure, especially when elective implantation is performed before development of inotropic dependency or cardiogenic shock. However, outcomes at 12 months in this selective elderly population remain uniformly poor.
年龄较大被认为是心脏移植的相对禁忌症，但在机械循环支持（MCS）的情况下，没有关于临界年龄的共识。这项单中心研究调查了在老年人中选择性与紧急实施永久性 MCS 的结果。
在 2006 年 1 月 1 日至 2009 年 4 月 1 日期间，我院对 31 名年龄>65 岁的患者进行了心室辅助装置（VAD）支持，VAD 用于永久性支持。28 名左 VAD（LVAD）受者分为两组：生存组，n = 13（在 180 天或撤机时持续 MCS）；和非生存组，n = 15（180 天内死亡）。此外，还分析了 LVAD 受者根据术前 INTERMACS（机械循环辅助机构注册）状态的生存率。
LVAD 患者的累积生存率在植入 VAD 后 30 天、180 天和 1 年分别为 75%、46%和 39%。INTERMACS 水平 I 至 III（n = 17）患者在 30 天、180 天和 1 年的累积生存率分别为 71%、47%和 35%，INTERMACS 水平 IV 至 V（n = 11）患者为 81%、45%和 45%（p = 0.9）。LVAD 受者的中位年龄为 69 岁（范围 66 至 80 岁）；4 名女性。中位支持时间为 565 天（范围 228 至 1257 天）。在 9 名受者中，支持仍在继续。均报告了并发症情况和死亡原因。
我们的经验表明，永久性 MCS 可能在患有终末期心力衰竭的高度选择的老年患者中获得成功，特别是在发生正性肌力依赖或心源性休克之前进行选择性植入时。然而，在这个选择性老年人群中，12 个月的结果仍然普遍较差。
