Heart transplantation in the young and elderly

Area of Science:

• Cardiology
• Transplantation Medicine
• Pediatric Cardiology

Background:

• Heart transplantation is a viable treatment for pediatric end-stage and complex congenital heart disease.
• Expanded donor criteria have enabled successful transplantation in older recipients.

Purpose of the Study:

• To evaluate the efficacy and long-term outcomes of orthotopic heart transplantation in pediatric and elderly patient groups.
• To compare survival rates and freedom from transplant coronary artery disease (TCAD) between these two distinct age cohorts.

Main Methods:

• A retrospective analysis of 39 pediatric patients (16 days to 17.6 years) and 123 elderly patients (60 to 74.8 years) who underwent heart transplantation between July 1994 and June 1998.
• Analysis of primary indications for transplantation, including dilated cardiomyopathy (DCM) and congenital heart disease in pediatric patients, and ischemic cardiomyopathy and DCM in elderly patients.

Main Results:

• Thirty-day, 1-year, and 4-year survival rates were 97.4%, 87.2%, and 70.9% for pediatric recipients, and 92.7%, 81.3%, and 79.3% for elderly recipients, respectively.
• One and 4-year freedom from TCAD was 100.0% and 85.3% in the pediatric group, versus 91.9% and 83.3% in the elderly group.

Conclusions:

• Orthotopic heart transplantation is an effective treatment for irreparable congenital and end-stage heart disease.
• The procedure offers excellent long-term results for both pediatric and elderly patient populations.