| Abstract
| - It is generally agreed that the upper age limit for hearttransplantation is 60 years. However, an increasing number of elderlycandidates are accepted for heart transplantation. We retrospectivelyanalyzed our experience with a total of 204 consecutive transplantations,performed in 195 adult patients (9 retransplantations) between March 1987and September 1993. There were 48 patients older than 60 years (mean 62.9+/- 3), group I (gr I) and 156 patients between 20 and 59 years old (mean47.5 +/- 8), group II (gr II). The two groups were matched for sex-ratio(female 10.4 vs 14.2%), indications (cardiomyopathy, ischemic, others), andhemodynamic parameters (pulmonary artery pressure, capillary wedgepressure, cardiac index). A ventricular assist device was used in 14patients as bridge to transplantation in gr II vs 0 to gr I. There wereseven early deaths in gr I (14.6%) vs 14 in gr II (8.97%, NS). A total of183 survivors (41 vs 142) have been followed up for 1 month-6.3 years (meanfollow-up 20.4 +/- 19.3 months in gr I, 35.4 +/- 23 in gr II). No patientwas lost to follow-up. There were 11 late deaths in gr I vs 16 in gr II.The most common cause was malignancy (n = 4) in gr I and sudden death (n =9) in gr II, with a significant difference. The actuarial survival was68.8% in gr I vs 88.5% in gr II at 1 year 43.5% in gr I vs 76.4% in gr IIat 5 years. In conclusion, transplanted patients over 60 years of age havea significantly poorer late survival than younger patients, despite similargood early results. Moreover, the causes of late deaths were different inthe two groups. So, heart transplantation in patients over 60 years of ageshould be carefully considered.
|
