ABSTRACT
Heart transplantation is considered the best treatment modality for advanced heart disease.While old age has conventionally been considered a contraindication for heart transplantation due to the reported adverse effect of advanced age,however donor hearts' shortage continues to stimulate the discussion about the recipient's upper age limit.Our study was based on a retrospective analysis for the results of 52 (18％) patients aged 60 years and older undergoing heart transplantation between May 2008 and December 2015,and these patients were compared with 236 (82％) adult recipients who were younger than 60 years at the time of transplantation and during the same period.In older group,71％ were males with the mean age of 63.38+3.55 years,and in younger group,83.4％ were males with a mean age of43.72±11.41 years (P=0.27).Dilated cardiomyopathy was the most common indication for transplantation among patients in both groups (P=0.147).In older group,the 3-month survival rate was higher than that in younger group (P=0.587),however the 6-month survival rate showed no significant difference (P=0.225).Although the 1-year survival rate was higher in older group (P=0.56),yet the 3-year survival rate between the two groups showed no statistically significant difference (P=0.48).According to our experience among older heart transplant candidates who were 60 years and older,we believe that advanced age should not be an excluding criterion to cardiac transplantation.
ABSTRACT
Aims: This study aims to evaluate benefit and safety compared dual antiplatelet therapy with single aspirin therapy after coronary artery bypass grafting. Study Design: A systematic review and Meta-analysis. Place and Duration of Study: Medline, Embase, ScienceDirect and Cochrane Library databases were searched for randomized controlled trials or observational studies focusing on anticoagulant therapy after coronary artery bypass grafting until December 2014. Methodology: Endpoints included postoperative mortality, bleeding events, myocardial infraction, stroke, repeat revascularization and graft occlusion. All these endpoints were compared between dual antiplatelet therapy and single aspirin therapy. Newcastle-Ottawa and Jadal scale were used to assess the quality of observational studies and randomized controlled trials respectively. Software R2.15.2 was utilized for Meta-analysis. Results: 15 studies composed of 31,365 patients were included. Compared with single aspirin therapy, dual antiplatelet therapy resulted in reducing risk of vein graft occlusion (OR=0.53, 95%CI 0.36-0.81, P=0.001), but no significant difference for artery graft occlusion (OR=0.91, 95%CI 0.39-2.12, P=0.882), Risk of postoperative mortality (OR=0.57, 95%CI 0.38-0.85, P=0.006) and repeat revascularization (OR=0.15, 95%CI 0.05-0.45, P=0.001) was also reduced. There were no significant difference for MI (OR=0.77, 95%CI 0.55-1.09, P=0.137), Stroke (OR=0.85, 95%CI 0.60-1.19, P=0.330) and bleeding (OR=0.95, 95%CI 0.82-1.09, P=0.465). In subgroup analysis of off-pump CABG, dual antiplatelet therapy reduced risk of graft occlusion (OR=0.49, 95%CI 0.30-0.82, P=0.006), MI (OR=0.28, 95%CI 0.11-0.72, P=0.009), mortality (OR=0.39, 95%CI 0.25-0.60, P<0.001), and did not increase risk of bleeding (OR=0.75, 95%CI 0.55-1.02, P=0.066). Conclusions: Dual antiplatelet therapy reduced risk of postoperative graft occlusion and mortality in the early and late postoperative phase after CABG. It appeared to be more beneficial for off-pump CABG.