Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Immohr, Moritz Benjamin; Aubin, Hug; Westenfeld, Ralf; Erbel-Khurtsidze, S.; Tudorache, I.; Akhyari, Payam; Lichtenberg, Artur; Boeken, Udo

doi:10.3390/jcm11040929

Cited by 8 publications

(3 citation statements)

References 25 publications

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“…The most likely mechanisms are the increased atherosclerosis to which these grafts are subjected, the greater rate of fibrosis, greater vulnerability to cold ischemic time, and valvular lesions [18]. This is confirmed by studies that showed that groups of elderly patients who received grafts from older donors showed a negative impact on one-year survival [19]. This is contrary to what is happening in the general practice in an attempt to widen the age limits.…”

Section: Agementioning

confidence: 99%

Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

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Section: Agementioning

confidence: 99%

Heart Transplantation

Chrysakis,

Magouliotis,

Spiliopoulos

et al. 2024

JCM

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“…However, data on long-term results, especially in elderly patients who are refractory to OMT, remain inconclusive, leaving a gray area with a number of unanswered questions ( 11 , 12 ). Primary or consecutive implantation of long-term mechanical circulatory systems or heart transplantation is not feasible for broad application, or even not possible in patients above 70 years of age ( 13 – 15 ). On the other hand, life expectancy is continuously rising among the elderly population.…”

Section: Introductionmentioning

confidence: 99%

Isolated annuloplasty in elderly patients with secondary mitral valve regurgitation: short- and long-term outcomes with a less invasive approach

Oezpeker,

Hoefer,

Barbieri

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLong-term outcomes of elderly and frail patients with secondary mitral valve regurgitation (MR) are inconclusive. Especially in patients with co-morbidities such as atherosclerosis who are suffering from heart failure, optimal medical therapy (OMT) is the preferred therapy relative to surgical or percutaneous interventions. It remains challenging to identify the most successful therapy to improve symptoms and increase life expectancy. To reduce surgical trauma for these patients, minimally invasive mitral valve surgery (MIMVS) was developed; this has shown promising medium-term results, but there is still a lack of evidence regarding long-term results. The aim of this investigation was to describe the long-term outcomes of less invasive mitral valve surgery (MVS) in elderly patients.MethodsIn this longitudinal retrospective analysis, 67 patients (aged ≥70 years) with secondary MR who underwent MV repair ± tricuspid valve repair (TVR) were identified. MVS was performed via minithoracotomy (MT) in most cases (n = 54); in patients with contraindications for MIMVS, partial upper sternotomy (PS) was the preferred route for surgical access (n = 13). The appropriate access route was chosen according to the patient's clinical condition and comorbidities. We analyzed reoperation-free long-term survival, combined operative success (lack of residual MR, conversion to MV replacement, or larger thoracic incisions), and perioperative safety (at 30 days: mortality, re-thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation, stroke, myocardial infarction). In a subgroup analysis, we compared long-term survival in MVS patients with and without TVR.ResultsThe median age of patients (62.7% female) was 74 years (interquartile range: 72–76 years), with a median EuroSCORE2 of 2.8% (1.5%–4.6%) and N-terminal pro-brain natriuretic peptide plasma levels of 1,434 ng/L (1035–2149 ng/L). The median follow-up period was 5.6 years (2.7–8.5 years). The reoperation-free long-term survival rate up to 10 years was 66.2%. Combined operative success and perioperative safety were achieved in 94% and 76% of patients, respectively. Additional TVR was performed in 56.7% of patients, without any significant difference in survival rates compared to the group without TVR (p = 0.417; HR 1.473, 95% CI 0.578–3.757).ConclusionLess invasive MV repair for secondary MR shows excellent operative success and safety in selected patients. Freedom from significant MR and from the need for reoperation indicates long-lasting efficacy. These results should be considered in heart team discussions regarding allocation of patients to surgical mitral procedures.

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“…The effect of donor parameters on outcome and survival after heart transplantation is crucial and is currently one of the most essential topics of organ acceptance [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. A potential donor risk factor for organ quality is the donor length of stay (LOS) in the ICU.…”

Section: Introductionmentioning

confidence: 99%

Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit

Oehler

Böttger

Immohr

et al. 2022

Life

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Prolonged treatment of organ donors in the intensive care unit (ICU) may be associated with complications influencing the outcome after heart transplantation (HTx). We therefore aim to explore the potential impact of the donor length of stay (LOS) in the ICU on outcomes in our cohort. We included all patients undergoing HTx in our center between September 2010 and April 2022 (n = 241). Recipients were divided around the median into three groups regarding their donor LOS in the ICU: 0 to 3 days (≤50th percentile, n = 92), 4 to 7 days (50th–75th percentile, n = 80), and ≥8 days (≥75th percentile, n = 69). Donor LOS in the ICU ranged between 0 and 155 days (median 4, IQR 3–8 days). No association between the LOS in the ICU and survival after HTx was observed (AUC for overall survival 0.514). Neither the Kaplan–Meier survival analysis up to 5 years after HTx (Log-Rank p = 0.789) nor group comparisons showed significant differences. Baseline recipient characteristics were comparable between the groups, while the donor baselines differed in some parameters, such as less cardiopulmonary resuscitation prior to HTx in those with a prolonged LOS. However, regarding the recipients’ peri- and postoperative parameters, the groups did not differ in all of the assessed parameters. Thus, in this retrospective analysis, although the donors differed in baseline parameters, the donor LOS in the ICU was not associated with altered recipient survival or outcome after HTx.

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Heart Transplantation of the Elderly—Old Donors for Old Recipients: Can We Still Achieve Acceptable Results?

Cited by 8 publications

References 25 publications

Heart Transplantation

Heart Transplantation

Isolated annuloplasty in elderly patients with secondary mitral valve regurgitation: short- and long-term outcomes with a less invasive approach

Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit

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