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Heart transplantation in selected patients aged 60 years and older: a two-decade retrospective and multicentre analysis

Abstract : OBJECTIVES: This study analysed survival and long-term outcomes of heart transplantation in patients aged 60 years and older. We also analysed the impact of a national graft allocation priority [Super Emergency (SE)] and compared survival with younger patients in our centres and in France. METHODS: We performed a multicentre (University Hospitals in Nantes, Rennes and Tours), 2-decade retrospective study between 1 January 1994 and 31 December 2013. Elderly recipients were placed on the same list as younger patients; the use of marginal donors remained occasional. RESULTS: A total of 212 patients aged between 60 and 68 years were included. The 1-, 5-, and 10-year survival rates were 83.2%, 77.4% and 63.8%, respectively, which were significantly worse than those of recipients aged <60 years (1-, 5-, and 10-year survival rates of 87.3%, 80.4% and 68.0%, respectively). The postoperative course was acceptable. The main cause of death was malignancy (29.8% in our cohort). Survival was similar between the first and second decades and among the SE group. Our population exhibited better survival than patients <60 years transplanted in France during the same period with 1-, 5-, and 10-year survival rates of 76.8%, 68.0% and 56.3%, respectively. Predictors of survival in the multivariate analysis included ischaemic cardiomyopathy [hazard ratio (HR) 4.1] and postoperative complications, such as dialysis (HR 9.5) and mechanical circulatory support (HR 4.2). CONCLUSIONS: We report positive postoperative course and long-term outcomes after heart transplantation in older recipients using conventional donors. Our satisfactory outcomes may be explained by the stringent selection of recipients combined with regular follow-up.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01518410
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Submitted on : Thursday, May 4, 2017 - 3:38:02 PM
Last modification on : Tuesday, July 30, 2019 - 3:26:03 PM

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Christian Bosseau, Bernard Lelong, Sabine Pattier, Jean-Noël Trochu, Jean-Christian Roussel, et al.. Heart transplantation in selected patients aged 60 years and older: a two-decade retrospective and multicentre analysis. European Journal of Cardio-Thoracic Surgery, Oxford University Press (OUP), 2017, 51 (5), pp.893-901. ⟨10.1093/ejcts/ezx040⟩. ⟨hal-01518410⟩

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