vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2016-4-56-65vtio-699Research ArticleКлиническая трансплантологияClinical TransplantologyПЕРИОПЕРАЦИОННЫЙ ПЕРИОД ПРИ ТРАНСПЛАНТАЦИИ СЕРДЦА У РЕЦИПИЕНТОВ 60 ЛЕТ И СТАРШЕEARLY POSTOPERATIVE PERIOD AFTER ORTHOTOPIC HEART TRANSPLANTATION IN RECIPIENTS OF 60 YEARS AND OLDERПопцовВ. Н.PoptsovV. N.

Адрес: 123182, Москва, ул. Щукинская, д. 1. Тел. (963) 644-96-39

Address: 1, Shchukinskaya st., Moscow, 123182, Russian Federation. Tel. (963) 644-96-39

poptsov_vit@mail.ruСпиринаЕ. А.SpirinaE. A.

Москва, Российская Федерация

Moscow, Russian Federation

УхренковС. Г.UkhrenkovS. G.

Москва, Российская Федерация

Moscow, Russian Federation

УстинС. Ю.UstinS. Yu.

Москва, Российская Федерация

Moscow, Russian Federation

АлиевЭ. З.AlievE. Z.

Москва, Российская Федерация

Moscow, Russian Federation

МасютинС. А.MasyutinS. A.

Москва, Российская Федерация

Moscow, Russian Federation

ВоронковВ. Ю.VoronkovV. Yu.

Москва, Российская Федерация

Moscow, Russian Federation

ЧибисовН. С.ChibisovN. S.

Москва, Российская Федерация

Moscow, Russian Federation

БондаренкоД. М.BondarenkoD. M.

Москва, Российская Федерация

Moscow, Russian Federation

МебонияН. З.MebonijaN. Z.

Москва, Российская Федерация

Moscow, Russian Federation

МожейкоН. П.MozheykoN. P.

Москва, Российская Федерация

Moscow, Russian Federation

ШевченкоА. О.ShevchenkoA. O.

Кафедра трансплантологии и искусственных органов ГБОУ ВПО «Первый Московскийгосударственный медицинский университет имени И.М. Сеченова» Минздрава России, Москва, Российская Федерация

Moscow, Russian Federation

ФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава РоссииРоссияV.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian FederationRussian FederationФГБУ «Федеральный научный центр трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России ГБОУ ВПО «Первый Московский государственный медицинский университет имени И.М. Сеченова» Минздрава РоссииРоссияV.I. Shumakov Federal Research Center of Transplantology and Artifi cial Organs of the Ministry of Healthcare of the Russian Federation I.M. Sechenov First Moscow State Medical UniversityRussian Federation2016280120171845665Copyright © Попцов В.Н., Спирина Е.А., Ухренков С.Г., Устин С.Ю., Алиев Э.З., Масютин С.А., Воронков В.Ю., Чибисов Н.С., Бондаренко Д.М., Мебония Н.З., Можейко Н.П., Шевченко А.О., 20172017Попцов В.Н., Спирина Е.А., Ухренков С.Г., Устин С.Ю., Алиев Э.З., Масютин С.А., Воронков В.Ю., Чибисов Н.С., Бондаренко Д.М., Мебония Н.З., Можейко Н.П., Шевченко А.О.Poptsov V.N., Spirina E.A., Ukhrenkov S.G., Ustin S.Y., Aliev E.Z., Masyutin S.A., Voronkov V.Y., Chibisov N.S., Bondarenko D.M., Mebonija N.Z., Mozheyko N.P., Shevchenko A.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/699Введение

Введение. Рост числа возрастных пациентов с терминальной ХСН приводит к увеличению их количества среди потенциальных реципиентов, нуждающихся в механической поддержке кровообращения и/или трансплантации сердца (ТС) [Abecassis M., Bridges N.D. et al., 2012].

Цель исследования

Цель исследования: анализ собственного опыта выполнения ТС у реципиентов старше 60 лет.

Материалы и методы

Материалы и методы. В исследование включили 63 больных: 59 мужчин (93,3%) и 4 (6,7%) женщины, возраст которых составил от 60 до 74 лет (63,0 ± 0,8), масса тела – 76,6 ± 1,4 кг, площадь поверхности тела (D) – 1,7 ± 0,02 м2, индекс массы тела (ИМТ) – 23,4 ± 0,6. Показания к ТС: дилатационная кардиомиопатия – 24 (38,1%), ИБС – 34 (54,0%), гипертрофическая кардиомиопатия – 2 (3,2%), необратимая дисфункция сердечного трансплантата – 3 (4,7%). Выраженность ХСН соответствовала III ФК по NYHA у 46 (73,0%) и IV ФК у 17 (23,0%). Транспульмональный градиент составил 11,2 ± 2,7 мм рт. ст., легочное сосудистое сопротивление – 3,5 ± 1,3 ед. Вуда. В соответствии с алгоритмом UNOS неотложность выполнения ОТС соответствовала 1А статусу у 10 (15,9%) пациентов (ВА ЭКМО, n = 8, и имплантируемый обход левого желудочка, n = 2), 1Б статусу – у 21 (33,3%) и 2-му статусу – у 32 (50,8%). Реципиенты имели следующую сопутствующую патологию: артериальная гипертензия (АГ) (n = 51; 81,0%), сахарный диабет (СД) (n = 6; 9,5%), цереброваскулярная болезнь (n = 13; 20,6%), перенесенное острое нарушение мозгового кровообращения (n = 9; 14,3%), диализ-независимая почечная дисфункция (n = 21; 33,3%). До ТС 9 (14,2%) реципиентов перенесли различные оперативные вмешательства на органах грудной клетки, 2 (3,2%) – на головном мозге. В 100% наблюдений (n = 63) выполнили дистанционный забор сердечного трансплантата от мультиорганного донора (49 (77,8%) мужчин и 14 (22,2%) женщин). Возраст сердечного донора составил от 18 до 59 (34,3 ± 10,4) лет.

Результаты

Результаты. Продолжительность лечения в условиях ОРИТ – от 4 до 15 (8,2 ± 0,5) суток. В 61,9% (n = 39) наблюдалось неосложненное течение раннего послеоперационного и госпитального периодов. Раннюю послеоперационную активизацию («ранняя» экстубация трахеи) на операционном столе выполнили у 32 реципиентов (50,8%) через 48 ± 6 мин после окончания оперативного вмешательства. У 2 (3,2%) реципиентов имела место ранняя дисфункция трансплантата, потребовавшая применения ВА ЭКМО. Осложнения, не связанные с дисфункцией трансплантата, развились у 24 (38,1%) реципиентов: преимущественно почечная дисфункция (n = 8; 12,7%), почечно-печеночная дисфункция (n = 4; 6,3%), инфекционные осложнения (бактериальная пневмония, n = 3; 4,8%), дисциркуляторная энцефалопатия (n = 9; 14,3%). Потребность в постоянной заместительной почечной терапии (ЗТП) имели 12 (19,0%), из них 10 (15,9%) с восстановлением почечной функции. Программный гемодиализ применили в 2 (3,2%) наблюдениях. Госпитальная (n = 6; 9,5%) летальность была обусловлена синдромом полиорганной недостаточности и сепсисом. Выживаемость после 1 года составила 87,5%, 3 лет – 86,8%.

Заключение

Заключение. Собственный опыт демонстрирует удовлетворительные показатели ранней и отдаленной выживаемости у реципиентов, которым трансплантацию сердца выполнили в возрасте 60 лет и старше.

Introduction

Introduction. 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

Aim. To analyze our own experience of HT in recipients of older 60 years.

Materials and methods

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

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

Conclusion. Our own experience demonstrates satisfactory short-term and long-term survival after heart transplantation in recipients of 60 years and older.

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The authors declare that there are no conflicts of interest present.