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Increased incidence of chronotropic incompetence in older donor hearts
E M Chau1, C G McGregor, R J Rodeheffer
1Department of Internal Medicine, Mayo Clinic, Rochester, Minn. 55905, USA.
Insights
Older donor hearts can be safely used in heart transplantation, showing excellent survival rates. However, recipients may have a higher risk of chronotropic incompetence requiring a permanent pacemaker.
Area of Science:
- Cardiology
- Transplantation Medicine
- Geriatric Cardiology
Background:
- Previous registry studies indicate increased early mortality with older donor hearts in heart transplantation.
- Donor age is a critical factor influencing heart transplant outcomes.
Purpose of the Study:
- To assess the impact of donor age on mortality and morbidity in heart transplant recipients.
- To evaluate the safety and efficacy of using older donor hearts (< 40 years vs. > 40 years).
Main Methods:
- Retrospective analysis of 77 heart transplantations between June 1988 and July 1994.
- Patients were grouped based on donor age: younger (< 40 years, n=60) and older (> 40 years, n=17).
- Comparison of mortality, 1-year survival, length of hospital stay, graft ejection fraction, and rejection episodes.
Main Results:
- No significant difference in 30-day mortality or 1-year survival rates between younger and older donor groups (95% vs. 100% at 1 year).
- No statistical differences in hospital stay, graft ejection fraction, or rejection episodes.
- Significantly higher incidence of chronotropic incompetence requiring permanent pacemaker implantation in the older donor group (41.2% vs. 10.3%).
Conclusions:
- Older donor hearts can be safely utilized in selected heart transplant recipients, achieving excellent outcomes.
- While overall survival is comparable, an increased risk of chronotropic incompetence necessitates pacemaker implantation in recipients of older donor hearts.
Background:
Previous Registry studies have reported that heart transplantation with older donor hearts is associated with a more than twofold increase in early mortality.
Methods:
An analysis of 77 consecutive patients undergoing heart transplantations at our institution between June 1988 and July 1994 was performed to assess the effect of donor age on mortality and morbidity. Recipients were grouped into those receiving hearts from younger donors (aged < 40 years, n = 60) and those receiving hearts from older donors (aged > 40 years, n = 17).
Results:
There were two deaths within the first 30 days in the younger donor group and no deaths in the other group. One-year survival rate was 95% and 100% for the "younger" and "older" groups, respectively. The mean recipient age of the younger donor group was lower (46 +/- 14 years) compared with the older donor group (57 +/- 7 years). Morbidity was compared between the two groups; the length of hospital stay (22.6 +/- 15.8 days versus 21.3 +/- 9.4 days), the graft ejection fraction at 1 week (64% +/- 5% versus 62% +/- 7%), and the mean number of rejection episodes within the first 3 months (0.79 versus 0.65) were not statistically different between the two groups. However, the incidence of chronotropic incompetence requiring permanent pacemaker implantation was significantly greater in the group who received older donor hearts (41.2% versus 10.3%, p < 0.05), independent of the ischemic time.
Conclusions:
This study shows that older donor hearts may be used safely in selected patients with excellent outcome, although there is an increased incidence of chronotropic incompetence requiring implantation of permanent pacemakers.