Division of Cardiac Surgery, the Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
Ann Thorac Surg. 2013 Apr;95(4):1251-60; discussion 1260-1. doi: 10.1016/j.athoracsur.2012.10.089. Epub 2013 Feb 22.
Although orthotopic heart transplantation (OHT) is increasingly being offered to older patients, few studies have evaluated outcomes in patients older than 70 years of age. We undertook this study to characterize the outcomes of septuagenarians bridged to transplantation (BTT) in the modern era.
We conducted a retrospective cohort study of all adult OHT in the United Network for Organ Sharing database from 2005 to 2011. Primary stratification was by age 70 years or older. Subgroup analysis evaluated patients who received BTT. The primary outcome was survival as determined by the Kaplan-Meier method.
From January 2005 to December 2011, 12,274 adults underwent OHT, including 3,243 (26.4%) who received BTT. In the entire cohort, 11,996 (97.7%) recipients were aged 18 to 70 years, and 277 (2.3%) were 70 years of age or older. Overall, patients 70 years or older who underwent OHT had decreased 90-day survival (93.6% versus 88.8%; p<0.01), 1-year survival (89.0% versus 81.6%; p<0.01), and 2-year survival (85.4% versus 79.9%; p<0.01) compared with recipients of other ages. However in the BTT subgroup, recipients 70 years and older (n=43) had similar 90-day (91.2% versus 84.7%; p=0.2), 1-year (86.1% versus 81.7%; p=0.4), and 2-year (82.8% versus 81.7%; p=0.6) survival compared with recipients of other ages (n=3,200). After adjusting for multiple recipient and donor factors, age greater than or equal to 70 years was still not associated with an increased hazard of mortality at 90 days, 1 year, or 2 years. These results were verified by analysis of a propensity-matched cohort.
Although patients older than the age of 70 years undergoing OHT have decreased survival, among patients who received BTT, septuagenarians have outcomes similar to those of younger recipients. In carefully selected patients dependent on left ventricular assist devices (LVADs), recipient age greater than or equal to 70 years should not be viewed as a contraindication to OHT.
尽管原位心脏移植（OHT）越来越多地应用于老年患者，但很少有研究评估 70 岁以上患者的结局。我们进行这项研究的目的是描述现代时代桥接移植（BTT）的 70 岁以上患者的结局。
我们对 2005 年至 2011 年期间美国器官共享网络数据库中的所有成人 OHT 进行了回顾性队列研究。主要分层是根据年龄是否大于或等于 70 岁。亚组分析评估了接受 BTT 的患者。主要结局是通过 Kaplan-Meier 方法确定的生存。
从 2005 年 1 月至 2011 年 12 月，12274 名成人接受了 OHT，其中 3243 名（26.4%）接受了 BTT。在整个队列中，11996 名（97.7%）受者年龄在 18 至 70 岁之间，277 名（2.3%）受者年龄大于或等于 70 岁。总体而言，接受 OHT 的 70 岁或以上患者的 90 天存活率（93.6%比 88.8%；p<0.01）、1 年存活率（89.0%比 81.6%；p<0.01）和 2 年存活率（85.4%比 79.9%；p<0.01）均低于其他年龄组的患者。然而，在 BTT 亚组中，70 岁及以上的患者（n=43）的 90 天（91.2%比 84.7%；p=0.2）、1 年（86.1%比 81.7%；p=0.4）和 2 年（82.8%比 81.7%；p=0.6）存活率与其他年龄组（n=3200）相似。在调整了多个受者和供者因素后，年龄大于或等于 70 岁与 90 天、1 年或 2 年的死亡风险增加无关。这一结果通过倾向评分匹配队列的分析得到了验证。
尽管接受 OHT 的 70 岁以上患者的存活率降低，但在接受 BTT 的患者中，70 岁以上的患者的结局与年轻患者相似。在依赖左心室辅助装置（LVAD）的精心选择的患者中，年龄大于或等于 70 岁不应被视为 OHT 的禁忌症。
