antioxidant balance and sepsis in cardiac surgery

CARDIAC

TRANSPLANTATION INFERIOR

IN PATIENTS OVER 60 YEARS LONG TERM RESULTS.

OF AGE:

J. NEIDECKER,J. ROBIN, M.C. LAROUX,P. BRULE, P. BOISSONNAT,J. N INET HOPITALCARD0VASCULAIRE L. PRADEL- 69394 LYON - (FRANCE)

Cardiac transplant programs have routinely excluded patients over 55 years of age from consideration as transplant candidates (1,2). Nevertheless some encouraging results of cardiac transplantation in patients over 60 years, showed no difference in infection rates between younger and older patients (2). Thus numbers of centres performed heart transplantation in older patients. This retrospective study analyses long term results and follow-up of adult heart transplantations focusing on patients over 60 years of age. PATIENTS AND METHOD: Between March 1987 and September 1993, 204 heart transplantations have been performed by one team of our institution in 195 patients. Patients were divided in 2 groups (group I : 20 to 59 years group II : 60 years and over). The 2 groups were screened for sex ratio, indications, haemodynamic data (Pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac index) using a Student’s t test and an actuarial survival analysis was performed (log rank test). RESULTS 156 patients (mean age 47.5 k8 years, range 2059) were in group I, while 48 (mean age 62.9 ?5 years, range 60-67.5) were in group II. Nine retransplantations have been performed: 8 in group I and 1 in group II. There was no statistical difference between the 2 groups (table 1). The follow up was possible in182 survivors ranging from 3 months to 6.3 years (mean 31.3 months). No patient was lost to follow up. Actuarial survival was significantly different (table 2) 1 year: group I 88.5% versus group II 68.8% (pcO.001); 5 years: group I 76.4% versus group II 36.2% (p =0.0008). Causes of late mortality were also different : sudden death 9 in group I versus 2 in group II, malignancies 1 in group I versus 4 in group II. COMMENTS Previous studies emphasized the good early results of heart transplantation in recipients over 60 years of age: no difference in 12 or 24 months actuarial life survival and similar or reduced number of early rejections (3,4). This study shows that one year survival rate is comparable to that of younger patients (no difference in early death), whereas five years survival deteriorates in older patients with an increased number of malignancies. In conclusion, heart transplantation should be considered with care in patients over 60 years of age: long term survival is less than optimal in this age group in the era of organ shortage.

90

TABLE 1 : PRE-OPERATIVE PATIENTS DATA GROUP I 134 22 83 43 23 7 31 24.3 23 1.86 14 (9%)

MALE FEMALE NOCM Isch. CM VALV MISC PAP PAOP EF Cl E.death

GROUP II 43 5 24 14 8 2 31 20 21 1.82 8 (14.6%)

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>CM: non obstructwe cararomyopatny, ~scn. I M: ischaemic cardiomyopathy, VALV: valvular cardiomyopathy, Mist: miscellaneous, PAP: mean pulmonary artery pressure, PAOP: pulmonary artery occlusion pressure, EF: ejection fraction, Cl: cardiac index, E. death: early death.

TABLE 2: ACTUARIAL SURVIVAL 100

20

Years

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REFERENCES

l-Frazier O.H., Macris M.P., Duncan J.M., et al. Cardiac transplantation over 60 years of age. Ann Thorac Surg 45:129-l 32, 1988. 2Copeland J.G. Cardiac transplantation after 60 years of age.Ann Thorac Surg 45:115-l 16, 1988. 3-Rendlund D.G., Gilbert E.M., O’Connell J.B., et al. Age-Associated decline in cardiac allograft rejection. Am J Med 83: 391-398, 1987. 4-Aravot D.J., Banner N.R., Khaghani A., et al. Cardiac transplantation in the seventh decade of life. Am J Cardio163: 90-93, 1989

Journal of Cardiothoraoc and Vascular Anesthesa, Vol8. No 5, Suppl 3 (October), EACTA 94 Abstracts: Cardiovascular Pharmacology

1994