Aortic Valve Replacement in the Elderly: The Real Life
Aortic Valve Replacement in the Elderly: The Real Life
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DOI：
10.1016/j.athoracsur.2011.07.033
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发表时间：
2012-01-01
影响因子：
4.6
通讯作者：
Leguerrier, Alain
中科院分区：
文献类型：
--
作者：
Langanay, Thierry;Flecher, Erwan;Leguerrier, Alain
背景主动脉瓣狭窄在老年人中是一个值得关注的问题。虽然主动脉瓣置换术提供了良好的长期生存与功能改善，许多老年患者仍然没有提到手术，因为他们的年龄。经皮主动脉瓣植入术是心内直视手术的一种替代方法。对老年人主动脉瓣狭窄的治疗问题进行综述。我们回顾性分析了自2000年1月以来1,193例连续主动脉瓣置换术的患者。共有657例患者（55%）至少有一种相关合并症（如呼吸衰竭），381例（32%）有相关冠状动脉病变。883例（74%）患者仅行瓣膜置换术，262例合并冠状动脉血运重建，48例合并其他心脏手术。总手术死亡率为6.9%（83/1193例患者）;单次置换术死亡率为5.5%，与冠状动脉搭桥术相关的死亡率为11.5%。单因素和多因素分析确定了11个与一般状况、心脏状况和手术本身相关的手术风险因素：年龄较大（p <0.015）;呼吸衰竭（p <0.001）;
Background. Aortic stenosis is of concern in the elderly. Although aortic valve replacement provides good long-term survival with functional improvement, many elderly patients are still not referred for surgery because of their age. Percutaneous aortic valve implantation offers an alternative to open-heart surgery. Concerns about the management of aortic valve stenosis in the elderly will be reviewed.Methods. We retrospectively analyzed 1,193 consecutive aortic valve replacements, performed in octogenarians since January 2000. A total of 657 patients (55%) had at least one associated comorbidity (eg, respiratory failure) and 381 (32%) associated coronary lesions. Valve replacement was the only procedure in 883 patients (74%), and was associated with coronary revascularization in 262 cases, or with another cardiac procedure in 48 patients.Results. Overall operative mortality was 6.9% (83 of 1,193 patients); 5.5% for single replacement and 11.5% if associated with coronary artery bypass surgery. Univariate and multivariate analyses identified 11 operative risk factors related to general status, cardiologic condition, and the procedure itself: older age (p< 0.015); respiratory failure (p