Posttransplant Outcomes Among Septuagenarians Bridged to Transplantation With Continuous-Flow Left Ventricular Assist Devices

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• 作者：Shinichi Fukuhara ; MD ; Koji Takeda ; MD ; PhD ; Alexander Blair ; MS ; Paul A. Kurlansky ; MD ; Hiroo Takayama ; MD ; PhD ; Yoshifumi Naka ; MD ; PhD ; ^{yn33@cumc.columbia.edu}
• 关键词：BTT ; bridge to transplant ; CF-LVAD ; continuous-flow left ventricular assist device ; CI ; confidence interval ; DRC ; device-related complications ; HR ; hazard ratio ; KPS ; Karnofsky performance score ; LVAD ; left ventricular assist device ; MCS ; mechanical circulatory support ; MELD-IX ; model for end-stage liver disease excluding international normalized ratio ; OR ; odds ratio ; UNOS ; United Network of Organ Sharing
• 刊名：The Annals of Thoracic Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：103
• 期：1
• 页码：41-48
• 全文大小：1136 K
• 卷排序：103

文摘

A bridge to transplant strategy with a continuous-flow left ventricular assist device is increasingly being offered to older patients. However, the upper patient age limit has not been defined.MethodsThe United Network of Organ Sharing (UNOS) database was used to identify 21,258 heart transplant recipients from 2004 to 2014. Of these, 4,850 (22.8%) were bridged with a continuous-flow left ventricular assist device. Recipients were stratified by age: group 1, aged 70 years or more (n = 115, 2.4%); and group 2, aged 18 to 69 years (n = 4,735, 97.6%).ResultsElderly patients more likely had ischemic etiology than younger patients (69.6% versus 41.0%; p < 0.001), and received a heart from an older donor (35.8 versus 31.3 years, p < 0.001) or an expanded criteria donor (8.7% versus 2.4%; p < 0.001). Elderly patients had decreased 90-day survival (88.8% versus 93.2%; p = 0.021) and 3-year posttransplant survival (80.9% versus 85.7%; p = 0.073). However, analysis of a propensity matched cohort did not demonstrate survival difference at 90 days and 3 years. Among septuagenarians, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was a predictor for 90-day mortality (hazard ratio 4.48, 95% confidence interval: 1.90 to 10.55; p = 0.001) and 3-year mortality (hazard ratio 2.27, 95% confidence interval: 1.51 to 3.41; p < 0.001), whereas functional independence was protective for 3-year mortality (hazard ratio 0.11, 95% confidence interval: 0.013 to 0.86; p = 0.036). Functionally independent patients showed a remarkably superior posttransplant survival compared with functionally dependent patients (96.7% versus 42.8% at 3 years; p = 0.001).ConclusionsThe continuous-flow left ventricular assist device supported septuagenarians did not have increased posttransplant mortality. Functional outcomes during device support may have important implications for organ allocation among the elderly.