Cascino Thomas M, Ling Carol, Likosky Donald S, Pagani Francis D, Cowger Jennifer
Division of Cardiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Department of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
J Heart Lung Transplant. 2025 Jun;44(6):995-999. doi: 10.1016/j.healun.2024.11.038. Epub 2024 Dec 4.
Patients 65 years of age or older represent the fastest-growing demographic group added to the U.S. heart transplant (HT) list. While post-HT outcomes appear acceptable, immortal time bias is introduced if adverse outcomes that occur while waiting for HT are not considered. Recent durable left ventricular assist device (dLVAD) technological innovations have engendered the question of whether this patient subgroup would achieve equivalent survival from a strategy of primary dLVAD implant as opposed to HT listing. We identified adults ≥65 years of age listed for HT between 2018 and 2021, excluding persons with dLVAD support and/or multiorgan listing. Among 1,176 patients, 2-year survival from HT listing was 78.4% ± 1.2%, similar to the 71% to 75% reported in The Society of Thoracic Surgeons (STS) Intermacs National Database for older adults. Linkage of the Scientific Registry of Transplant Recipients with STS Intermacs would enable comparative effectiveness analyses of surgical heart failure therapeutic strategies in high-risk patient cohorts.
65岁及以上的患者是被添加到美国心脏移植（HT）等候名单中的增长最快的人口群体。虽然心脏移植后的结果似乎可以接受，但如果不考虑等待心脏移植期间发生的不良后果，就会引入不朽时间偏倚。近期耐用左心室辅助装置（dLVAD）的技术创新引发了一个问题，即与列入心脏移植等候名单相比，该患者亚组通过初次植入dLVAD策略是否能获得同等的生存率。我们确定了2018年至2021年间列入心脏移植等候名单的65岁及以上成年人，排除接受dLVAD支持和/或多器官列入等候名单的人。在1176名患者中，从列入心脏移植等候名单起的2年生存率为78.4%±1.2%，与美国胸外科医师协会（STS）Intermacs国家数据库中报告的老年人71%至75%的生存率相似。将移植受者科学注册库与STS Intermacs相联系，将能够对高危患者队列中的手术性心力衰竭治疗策略进行比较有效性分析。
