AORTIC-VALVE REPLACEMENT FOR AORTIC-STENOSIS IN PERSONS AGED 80 YEARS AND OVER
AORTIC-VALVE REPLACEMENT FOR AORTIC-STENOSIS IN PERSONS AGED 80 YEARS AND OVER
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DOI：
10.1016/0002-9149(91)90937-g
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发表时间：
1991-06-01
影响因子：
2.8
通讯作者：
SPENCER, FC
中科院分区：
文献类型：
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作者：
CULLIFORD, AT;GALLOWAY, AC;SPENCER, FC
71例年龄大于或等于80岁(平均+/-标准差82+/-2)的主动脉瓣狭窄或混合狭窄合并反流的患者接受了主动脉瓣置换术(n=35，组1)或联合冠状动脉搭桥术(n=36，组2)。手术前，91%的患者有严重的心脏限制(纽约心脏协会III级或IV级)。住院死亡率为12.7%(9/71)，组1为5.7%(2/35)，组2为19.4%(7/36)。围手术期有1例患者发生中风(1.4%)。晚期心源性死亡1年和3年存活率分别为98.2%和95.5%，100%接受单纯主动脉瓣置换，96.3%和91.2%接受主动脉瓣置换加冠状动脉搭桥术。83%的幸存患者有明显的症状改善。术后1年和3年，无瓣膜相关并发症(血栓栓塞症、抗凝剂、心内膜炎、再手术或假体衰竭)发生率分别为93.3%和80.4%。因此，在年龄大于或等于80岁的患者中，因主动脉瓣狭窄而行主动脉瓣置换术后的短期和长期发病率和死亡率是令人鼓舞的低，尽管冠状动脉旁路移植增加了短期和长期死亡率。
Seventy-one patients aged greater-than-or-equal-to 80 years (mean +/- standard deviation 82 +/- 2) with aortic stenosis or mixed stenosis and regurgitation underwent aortic valve replacement alone (n = 35, group 1) or in combination with a coronary artery bypass procedure without any other valve procedure (n = 36, group 2). Preoperatively, 91% had severe cardiac limitations (New York Heart Association class III or IV). Hospital mortality was 12.7% overall (9 of 71), 5.7% (2 of 35) for group 1 and 19.4% (7 of 36) for group 2. Perioperatively, 1 patient (1.4%) had a stroke. Survival from late cardiac death at 1 and 3 years was 98.2 and 95.5%, respectively, for all patients, 100% for patients who underwent isolated aortic valve replacement, and 96.3 and 91.2%, respectively, for patients who underwent aortic valve replacement plus coronary artery bypass. Eighty-three percent of surviving patients had marked symptomatic improvement. Freedom from all valve-related complications (thromboembolism, anticoagulant, endocarditis, reoperation or prosthetic failure) was 93.3 and 80.4% at 1 and 3 years, respectively. Thus, short- and long-term morbidity and mortality after aortic valve replacement for aortic stenosis in patients aged greater-than-or-equal-to 80 years are encouragingly low, although the addition of coronary artery bypass grafting increases short-and long-term mortality.