Pederzolli C, Martinelli L, Grande A M, Goggi C, Minizioni G, Castiglione N, Gavazzi A, Campana C, Viganò M
Divisione di Cardiochirugia Centro C. Dubost, IRCCS Policlinico S. Matteo, Pavia.
G Ital Cardiol. 1997 Mar;27(3):263-9.
The age of recipient has been thought for several years to be one of the most important predictors of survival after heart transplantation. Therefore patients older than age 50 years were usually excluded from heart transplantation. The marked improvement in survival after clinical introduction of cyclosporine made a critical revision of selection criteria for heart recipients. In this article we retrospectively analyze the outcome of heart transplantation dividing the patients into two groups: Group A < or = 55 years, Group B > 55 years respectively.
We analyzed 437 patients who underwent heart transplantation, immunosuppressive protocol for all the patients was cyclosporine, azathioprine and prednisone. Group A included 284 patients, Group B 153 patients. We studied demographic, clinical and haemodynamic data pre- and post-operatory in both groups.
In Group A was more frequent dilated cardiomyopathy (p < 0.01) and the patients arrived at heart transplantation in worse haemodynamic conditions requiring more frequently inotropic infusion and/or mechanical support (intraaortic balloon pump, left ventricular assist device). Post-operatory course was more complicated in Group B patients where ischemic cardiomyopathy was more frequent (p < 0.001); intensive care stay, inotropic drugs infusion, mechanical ventilation and hospital mortality were higher in Group B, although non significantly. The donor age was significantly higher in Group B (p < 0.001), anyway the statistical analysis did not show a correlation between donor age and more complicated post-operative course. Follow-up did not show significative differences in the two groups considering haemodynamic data, metabolic disorders, graft coronary disease, infection and rejection rates. On Group B is significantly higher tumor incidence (p < 0.05) and peripheral vascular complications (p < 0.01). Actuarial survival at 5 and 7 years is respectively in Group A 80.3 and 72.9%, in Group B 75.4 and 71% (p = ns).
Heart transplantation in patients older than 55 years with end-stage heart disease is a valid therapeutic option with excellent long-term survival; pre-operative screening must be particularly accurate and older donors should be considered.
多年来，受者年龄一直被认为是心脏移植术后生存的最重要预测因素之一。因此，年龄超过50岁的患者通常被排除在心脏移植之外。环孢素临床应用后生存率的显著提高促使对心脏移植受者选择标准进行重大修订。在本文中，我们回顾性分析心脏移植的结果，将患者分为两组：A组年龄≤55岁，B组年龄>55岁。
我们分析了437例接受心脏移植的患者，所有患者的免疫抑制方案均为环孢素、硫唑嘌呤和泼尼松。A组包括284例患者，B组153例患者。我们研究了两组患者术前和术后的人口统计学、临床和血流动力学数据。
A组扩张型心肌病更为常见（p<0.01），且患者在心脏移植时血流动力学状况较差，更频繁地需要使用正性肌力药物输注和/或机械支持（主动脉内球囊反搏、左心室辅助装置）。B组患者术后病程更为复杂，其中缺血性心肌病更为常见（p<0.001）；B组患者重症监护停留时间、正性肌力药物输注、机械通气和医院死亡率更高，尽管无显著差异。B组供者年龄显著更高（p<0.001），无论如何，统计分析未显示供者年龄与更复杂的术后病程之间存在相关性。随访时，考虑血流动力学数据、代谢紊乱、移植冠状动脉疾病、感染和排斥率，两组之间未显示出显著差异。B组肿瘤发生率（p<0.05）和外周血管并发症（p<0.01）显著更高。A组5年和7年的精算生存率分别为80.3%和72.9%，B组为75.4%和71%（p=无显著性差异）。
对于年龄超过55岁的终末期心脏病患者，心脏移植是一种有效的治疗选择，长期生存率良好；术前筛查必须特别准确，应考虑使用年龄较大的供者。
