The utility of exercise testing after cardiac transplantation in older patients

Background The criteria for cardiac transplantation recipient selection, in cluding the appropriate recipient upper age limit, continue to expand with an increasing number of recipients greater than 60 years of age. While othe rs have reported their transplant experience in older recipients in terms o f quality of life assessment, me have examined the role of exercise cardiop ulmonary testing post-transplantation in older cardiac transplant recipient s. Methods. We reviewed inpatient and outpatient charts of 28 patients 60 year s of age or older who underwent orthotopic heart transplantation at Vanderb ilt University Medical Center. Results. In this population, perioperative mortality of 7.1% and Kaplan-Mei er survival at 1 and 5 years of 89 and 77%, respectively, were similar to t he institutional 1-year (89%) and 5-year (75%) survival among younger adult transplant recipients. Exercise cardiopulmonary testing results were avail able in 22/25 patients surviving greater than 1 year. Both peak oxygen cons umption and percentage of maximum VO2 were significantly greater among pati ents reporting NYHA Class 1 or 2 functional status, in comparison with thos e NYHA Class 3 or greater. Conclusion. Following cardiac transplantation, survival of patients greater than 60 years of age is equivalent to that of younger patients at our inst itution. Exercise testing provides an objective measure of performance and correlates with subjective status following heart transplantation. Most pat ients demonstrate good functional status, with minimal symptoms and good ex ercise capacity. These results, although retrospective, suggest that cardia c transplantation remains a reasonable therapeutic option for patients grea ter than 60 years of age with end-stage cardiomyopathy. (C) 1999 Academic P ress.