Open AccessEARLY POSTOPERATIVE PERIOD AFTER ORTHOTOPIC HEART TRANSPLANTATION IN RECIPIENTS OF 60 YEARS AND OLDER
Author(s) -
В. Н. Попцов,
Е. А. Спирина,
С. Г. Ухренков,
S. Yu. Ustin,
Э. З. Алиев,
S. A. Masyutin,
V. Yu. Voronkov,
N. S. Chibisov,
Д. М. Бондаренко,
N. Z. Mebonija,
N. P. Mozheyko,
А. О. Шевченко
Publication year - 2017
Publication title -
vestnik transplantologii i iskusstvennyh organov
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.137
H-Index - 5
eISSN - 2412-6160
pISSN - 1995-1191
DOI - 10.15825/1995-1191-2016-4-56-65
Subject(s) - medicine , cardiology , transplantation , heart transplantation , vascular resistance , body surface area , cardiomyopathy , cardiac index , dilated cardiomyopathy , heart failure , body mass index , diabetes mellitus , pulmonary hypertension , circulatory system , blood pressure , cardiac output , endocrinology
. Increase in the number of older patients with terminal CHF results in increase in their proportion among potential recipients requiring mechanical circulatory support and/or heart transplantation (HT) [Abecassis M., Bridges N.D. et al., 2012]. Aim. To analyze our own experience of HT in recipients of older 60 years. Materials and methods . The study included 63 patients (56 men (93.3% ) and 4 (6.7%) women) aged 60–74 years (63.0 ± 0.8) with body weight of 76.6 ± 1.4 kg, body surface area of 1.7 ± 0.02 m2, and body mass index of 23.4 ± 0.6. Indications for heart transplantation: dilated cardiomyopathy – 24 (38.1%), coronary heart disease – 34 (54.0%), hypertrophic cardiomyopathy – 2 (3.2%), irreversible cardiac graft dysfunction – 3 (4.7%). 46 (73.0%) patients had NYHA functional Class III and 17 (23.0%) patients – Class IV. Transpulmonary pressure gradient was 11.2 ± 2.7 mmHg, pulmonary vascular resistance – 3.5 ± 1.3 Wood units. According to UNOS algorithm 10 (15.9%) patients were listed as Status 1A of urgency of orthotopic cardiac transplantation (VA ECMO, n = 8, and implantable left ventricular assist device, n = 2), 21 (33.3%) patients as Status 1B, and 32 (50.8%) patients as Status 2. Recipients had the following comorbidities: arterial hypertension (n = 51; 81.0%), diabetes mellitus (n = 6; 9.5%), cerebrovascular disease (n = 13; 20.6%), history of stroke (n = 9; 14.3%), dialysisindependent renal dysfunction (n = 21; 33.3%). Before cardiac transplantation 9 (14.2%) recipients underwent various thoracic surgeries, 2 (3.2%) recipients – brain surgery. Heart donors (49 (77.8%) men and 14 (22.2%) women) were aged 18–59 (34.3 ± 10.4) years. Results . ICU hospitalization lasted for 4–15 (8.2 ± 0.5) days. In 61.9% of cases (n = 39) early postoperative and hospital periods were uncomplicated. Early on-table postoperative activation («early» tracheal extubation) was performed in 32 (50.8%) patients in 48 ± 6 minutes after surgery completion. 2 (3.2%) recipients demonstrated early graft dysfunction and required VA ECMO. Complications other than graft dysfunction were in 24 (38.1%) recipients: renal dysfunction (n = 8; 12.7%), renal and hepatic dysfunction (n = 4; 6.3%), infections (bacterial pneumonia, n = 3, [4.8%]), dyscirculatory encephalopathy (n = 9; 14.3%). 12 (19.0%) patients required continuous renal replacement therapy, 10 of them (15.9%) demonstrated renal function recovery. In 2 (3.2%) cases long-term hemodialysis was used. Hospital lethality (n = 6; 9.5%) was due to multiple organ failure syndrome and sepsis. Conclusion. Our own experience demonstrates satisfactory short-term and long-term survival after heart transplantation in recipients of 60 years and older.