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Partial Left Ventriculectomy in Elderly Patients Not Suitable for Heart Transplantation
Author(s) -
Shimura Shinichiro,
Kawaguchi Akira T.,
Bocchino Lise,
Takeshita Noriaki,
Batista Randas J.V.
Publication year - 2005
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2005.00153.x
Subject(s) - medicine , transplantation , heart transplantation , immunosuppression , surgery , coronary artery disease , cardiology , bypass grafting , artery
Background: Although donor scarcity and intolerance to immunosuppression tend to exclude elderly patients from transplantation, partial left ventriculectomy (PLV) has been performed without bias against advanced age. Methods: Among 392 patients undergoing PLV, 61 elderly patients aged 65 or older (≥65) were compared with the rest of the patients in terms of underlying disease, postoperative course, and survival time. Results: The aged patients (≥65), as compared to younger patients (<65), had ischemic disease (37.7% vs. 19.3%, p < 0.05) more frequently than cardiomyopathy (34.4% vs. 43.2%) or valvular disease (23.9% vs. 16.4%) and underwent lateral PLV (74% vs. 79%) more frequently than extended PLV (26% vs. 21%). Although the elderly patients required coronary bypass grafting more frequently (39.3% vs.17.2%, p < 0.05), surgical complexity was similar in terms of bypass time (63 minutes vs. 63 minutes) and percentage requiring cardiac arrest (31% vs. 44%). Despite advanced age, they required comparable ICU care (6.6 days vs. 5.4 days) and postoperative hospital stay (12 days vs. 11 days), resulting in a low but similar hospital survival (57% vs. 62%) and functional capacity after discharge (NYHA class 1.5 vs. 1.4). Conclusion: The results suggest that PLV can be performed in elderly patients (≥65 years) with comparable risks and benefits with the younger patients, promoting its application in patients disqualified for heart transplantation because of age criteria.