title: The utility of exercise testing after cardiac transplantation in older patients.
abstract: BACKGROUND
  The criteria for cardiac transplantation recipient selection, including the appropriate recipient upper age limit, continue to expand with an increasing number of recipients greater than 60 years of age. While others have reported their transplant experience in older recipients in terms of quality of life assessment, we have examined the role of exercise cardiopulmonary testing post-transplantation in older cardiac transplant recipients.
  
  
  METHODS
  We reviewed inpatient and outpatient charts of 28 patients 60 years of age or older who underwent orthotopic heart transplantation at Vanderbilt University Medical Center.
  
  
  RESULTS
  In this population, perioperative mortality of 7.1% and Kaplan-Meier survival at 1 and 5 years of 89 and 77%, respectively, were similar to the institutional 1-year (89%) and 5-year (75%) survival among younger adult transplant recipients. Exercise cardiopulmonary testing results were available in 22/25 patients surviving greater than 1 year. Both peak oxygen consumption and percentage of maximum VO2 were significantly greater among patients reporting NYHA Class 1 or 2 functional status, in comparison with those NYHA Class 3 or greater.
  
  
  CONCLUSIONS
  Following cardiac transplantation, survival of patients greater than 60 years of age is equivalent to that of younger patients at our institution. Exercise testing provides an objective measure of performance and correlates with subjective status following heart transplantation. Most patients demonstrate good functional status, with minimal symptoms and good exercise capacity. These results, although retrospective, suggest that cardiac transplantation remains a reasonable therapeutic option for patients greater than 60 years of age with end-stage cardiomyopathy.
authors.affiliation: Department of Veterans Affairs Medical Center, The Vanderbilt University School of Medicine and the Surgical Service, Nashville, Tennessee, 37212-2637, USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Chang
authors.forename: Y
authors.initials: Y
authors.lastname: Shyr
authors.forename: J
authors.initials: J
authors.lastname: Groves
authors.forename: D B
authors.initials: DB
authors.lastname: Chomsky
authors.forename: S F
authors.initials: SF
authors.lastname: Davis
authors.forename: J R
authors.initials: JR
authors.lastname: Wilson
authors.forename: D C
authors.initials: DC
authors.lastname: Drinkwater
authors.forename: R N
authors.initials: RN
authors.lastname: Pierson
authors.forename: W H
authors.initials: WH
authors.lastname: Merrill
mesh_terms: D000368:Aged; D000375:Aging; D005080:Exercise Test; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents