UNOS 2 statüsündeki son dönem kalp yetersizliği hastalarında kalp naklinin mortaliteye etkisi
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Tarih
2006
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info:eu-repo/semantics/openAccess
Özet
Amaç: Medikal ve cihazlı destek tedavilerindeki son gelişmelere rağmen UNOS 2 (United Network for Organ Sharing) statüsündeki son dönem kalp yetersizliği hastalarında tedavi stratejileri halen tartışmalıdır. Bu çalışmada, UNOS 2 son dönem kalp yetersizliği olan ve kalp nakli bekleme listesine alınan hastaların bekleme sürecindeki klinik durumları ve prognozları incelendi. Çalışma planı: Çalışmada UNOS 2 statüsünde olan ve kalp nakli programına alınan 78 hasta (62 erkek, 16 kadın; ort. yaş 43±12) incelendi. Nakil programına alındıktan sonra hastaların kalp yetersizliği nedeniyle hastaneye yatış sıklığı, bir üst UNOS sınıfına ilerleme, nakil yapılıp yapılmadığı ve mortalite oranları değerlendirildi. Bulgular: Hastaların listede bekleme süresi ortalama 17±10 ay idi. Kalp yetersizliği nedeniyle hastaneye yatış sıklığı 4±2/yıl bulundu. Yedi hastaya (%9) devamlı ventrikül taşikardisi nedeniyle kardioverter defibrilatör takıldı. Dokuz hastada (%11.5) UNOS 1B’ye ilerleme görüldü. On sekiz hastaya (%23.1) listede altı aylık bekleme süresinden sonra ortotopik kalp nakli uygulandı. Kalp nakli uygulanan hastalarda mortalite oranı %22.2 (4 hasta), bekleme listesinde olan hastalarda ise %25 (15 hasta) bulundu (p=0.03). Nakil listesindeyken kaybedilen hastaların 11’inde (%73.3) neden ani ölüm idi. Nakil uygulanan hastalarla izlemdeki hastalar sonlanım noktası olarak mortalite ve UNOS 1B’ye ilerleme açısından karşılaştırıldığında, nakil yapılmayan grupta oran anlamlı derecede daha yüksek idi (24 hasta, %40 ve 4 hasta, %22.2; p=0.01). Sonuç: UNOS 2 statüsündeki hastalarda ilerideki klinik kötüleşmelerin, sık kalp yetersizliği ataklarının ve kardiyak ölümlerin önlenmesi açısından kalp nakli uygun bir tedavi seçeneğidir.
Objectives: Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation. Study design: The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality. Results: The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01). Conclusion: Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2.
Objectives: Despite recent developments in medical treatments and assist device applications, management strategies for end-stage heart failure patients with UNOS status 2 (United Network for Organ Sharing) are still controversial. We evaluated the clinical condition and prognosis of end-stage heart failure patients with UNOS status 2, who were placed on the waiting list for heart transplantation. Study design: The study included 78 patients (62 men, 16 women; mean age 43±12 years) with UNOS status 2. The patients were assessed in terms of frequency of hospitalization during waiting for transplantation, shift to a higher level of UNOS status, transplantations performed, and mortality. Results: The mean duration of waiting on the list was 17±10 months. The frequency of hospitalization due to heart failure was 4±2/year. An implantable cardioverter defibrillator was used in seven patients (9%) for persistent ventricular tachycardia. Nine patients (11.5%) shifted to UNOS status 1B. Eighteen patients (23.1%) underwent orthotopic heart transplantation following six months of waiting on the list. Mortality rates were 25% (n=15) and 22.2% (n=4) for patients on the waiting list and for transplant patients at the end of the first year of transplantation, respectively (p=0.03). The main cause of mortality was sudden cardiac death (73.3%, n=11) for patients on the transplantation list. There was a significant difference in terms of combined end-point of mortality and shift to UNOS status 1B between transplanted (n=24, 40%) and untransplanted (n=4, 22.2%) patients (p=0.01). Conclusion: Heart transplantation is an appropriate alternative for preventing impending clinical deterioration, frequent attacks of heart failure, and cardiac deaths in patients with UNOS status 2.
Açıklama
Anahtar Kelimeler
Kalp ve Kalp Damar Sistemi
Kaynak
Türk Kardiyoloji Derneği Arşivi
WoS Q Değeri
Scopus Q Değeri
Cilt
34
Sayı
8
