тс сегодня и завтра, алма ата 2011

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1

.., III - 25.04. 2012

1 2.5% 0.42% 5- - 65%, - 47% III-IV 30 -70% 4% 1%

*Rich M. J Am Geriatric Soc. 1997;45:968974.American Heart Association. 2003 Heart and Stroke Statistical Update. Dallas, Texas: AHA 2003.

J.Hardy (1964) C.Barnard (1967) (P.Caves 1973) - (1981) -

3,608100,210- 694,2483,16838,119

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 This figure includes only the heart transplants that are reported to the ISHLT Transplant Registry. As such, the presented data may not mirror the changes in the number of heart transplants performed worldwide.

3,42,54,42,32,96,156,1 7,32,660,67,40,7 (1 . )

1968 . 18

,

- -

24/9,27,1/4,715,9/10,446/34,328/15,941/25,3 27/16,724/13,23,8/31,8/0,8 / (1 . ) < 55 :- - - - - - - - , B C ( < 15 //.) 93,9%

(n 61)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

(N=11,861)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

10- ( )

Multivariable analysis was performed using a proportional hazards model censoring all patients at 10 years. Continuous factors were fit using a restricted cubic spline.

Analyses were limited to transplants having essentially complete information regarding risk factors.

(//) n (%)0,20,1 26 (45,5%)5,32,512 (20,5%) + 0,50,01 2,10,0510 (13,6%) + 0,10,05 0,50,15 (4,5%) -8 (13,6%) 7- 48 (16,68) .

(n 61) 5 O(I) (III) AB(IV) (n 61) < 45% 2. 4 6 1 1 1 5 10 / 2 < 16 3 (n 61) - , , 45-55%, , = 2 . > 35 , - , - ( ), , . , ,

20% 1,8 ..2 < 45 Hg 15 Hg Wood 6 . VO2 max 12 // Na < 135 / > 600 / > 0,6 1- < 50% NYHA III IV

19

(N=10,271)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 ( )Multivariable analysis was performed using a proportional hazards model censoring all patients at 1 year. Continuous factors were fit using a restricted cubic spline.

Analyses were limited to transplants having essentially complete information regarding risk factors.

,

, , .

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 ( )Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients. The half-life is the estimated time point at which 50% of all of the recipients have died.

Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons.

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 The age distribution of heart transplant recipients was compared between the eras using a chi-square test. A significant p-value means that at least one of the groups is different than the others but it doesnt identify which group it is.

10- ( )

(N=11,861)J Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ISHLTMultivariable analysis was performed using a proportional hazards model censoring all patients at 10 years. Continuous factors were fit using a restricted cubic spline.

Analyses were limited to transplants having essentially complete information regarding risk factors.

41,1+2,2 . 128+89

.. NYHA (n 61)

- 65 . (> 6 . Wood, >15 ..). ( a, ) ( ) - ,

10- ( )

(N=11,861)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Multivariable analysis was performed using a proportional hazards model censoring all patients at 10 years. Continuous factors were fit using a restricted cubic spline.

Analyses were limited to transplants having essentially complete information regarding risk factors.

( - n 18) (- n 17) ( - n 10)

3019,1% , + (n 4) , + (n 3) , + (n 1) , (n 2) 946 + 89,8 n 10

31

HeartMate II - 17 NYHA III - 3 IV - 14 LVAD - 11 Thoratec - 3 HeartMate II - 4 Incor - 2 Duraheart - 2

BiVAD (Thoratec) - 6

() - 464 / - 15/2 - 13 - 4 - 8 - 5

() 19737

Thoratec

IncorDuraheart

( n 17)32%

* LVAD, RVAD, TAH

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 LVADBIVAD

BIVAD (n 6)

LVAD (n 11)

BIVAD (n 6)

LVAD (n 11), //21,340,11,370,21,90,2* *3,20,2* *, ...24,0 2,024,3 2,716 1,5 * *9,0 1,7 * *, ...18,0 2,213,6 0,29,0 1,2 * *7,0 0,9 * *, gm/m210,35 2,29,2 1,225,6 2,3 * *34,1 2,9 * *, gm/m27,6 0,29,7 2,43,8 0,2 * *7,5 0,3 * *, ds/cm-51661 2111540 2871197 202 * *1351 154 * / (%)14.33.6/30.53.522.08.6/34.45.116.73.8/44.04.6 * *28.314.5/40.10.9 * *, ds/cm-5323 27363 38294 19 * 365 31* * p < 0,05 * p < 0,01 ( n 17)

35

%

()

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 ( )Survival was calculated using the Kaplan-Meier method, which incorporates information from all transplants for whom any follow-up has been provided. Since many patients are still alive and some patients have been lost to follow-up, the survival rates are estimates rather than exact rates because the time of death is not known for all patients.

Survival rates were compared using the log-rank test statistic. No adjustments were made for multiple comparisons. Only pair-wise comparisons statistically significant at p 0.05 are shown on the slide. VO2 max (//)BNP(/)11,0 0,61316 112

16,7 2,6**541 37**13,2 1,3*1860 78**

* * p < 0,05 * p < 0,01

(n 61) () () (%) GS (%)309.676.2248.8 64.718,757,3

- 5.11.4

188,120,86 161,5 40,41 21.74.4- 3,60,45 * 429,7207,3*371,7190,1 *

15,7 5,1 *

- 4,8 0,9* p < 0,01

(n 61) () () (%)TAPSE() GS (%)105.538.568.132.638.112.311.84.3- 9.11.2131.17.9 *88.865.9 *37.313.811.52.1- 9.01.276.217.440.7510.142.33.412.73.5 - 9.40.08* p < 0,01

(n 61) IA (34%) :- LVAD/BiVAD < 30 > 30 , IB (37%) / : - LVAD/BiVAD > 30 II (26%) , IB IA

(UNOS Exetcutiv Order, 1999) (HLA) - T-. cross-math test - (PRA) > 10-15% - PRA ,

(PRA)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132 Only known PRA values are included in the tabulation.

- ~ 3000

8-350

92-270 . (143,552)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

(N=10,271)

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

10- ( )Multivariable analysis was performed using a proportional hazards model censoring all patients at 1 year. Continuous factors were fit using a restricted cubic spline.

Analyses were limited to transplants having essentially complete information regarding risk factors.

- 61 () - 250 24 () - 90 12 () - 5,5 1 () - 10 6 (.) - 9 3 (.) - 30 6 - 8,3% - 82,7%

1 3 () 49 (//2)1,89 0,42,89 0,4 ././. ( ..)42/22/27 628/15/19 6 ( ..)16,4 3,010,1 2,1 ( ..)12,9 0,16,4 2,2 (ds/cm-5)11 4879 67BNP (/)1333 234101 18 6 ()112 43480 87 - ()

-

(global strain) - 52 +712-8RVAD11125 ()53

2 :

: - () - - mycophenolate mofentil ()

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1132

ISHLTJ Heart Lung Transplant. 2011 Oct; 30 (10): 1071-1

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