Octogenarians Undergoing Combined Aortic Valve Replacement and Myocardial Revascularization: Perioperative Mortality and Medium-Term Survival
Octogenarians Undergoing Combined Aortic Valve Replacement and Myocardial Revascularization: Perioperative Mortality and Medium-Term Survival
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DOI：
10.1055/s-0029-1240832
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发表时间：
2010-04-01
影响因子：
1.5
通讯作者：
Cremer, J.
中科院分区：
文献类型：
--
作者：
Boening, A.;Lutter, G.;Cremer, J.
目的：探讨高龄患者接受主动脉瓣置换术和心肌血运重建术(AVR+CABG)的病死率和发病率是否高于年轻患者。年龄>80岁37例(男16例，女21例，主动脉瓣上压差中位数53 mm Hg，中位EF：62%)；年龄<80岁205例(男133例，女72例，中位梯度48 mm Hg，中位EF：61%)。80+组的NYHA分级、主动脉瓣面积和瓣膜钙化程度较差。94.6%的老年人和45.4%的年轻患者植入了生物瓣膜(p<；0.001)。结果：80岁以上组的围术期并发症发生率(86.5%)高于80岁组(66.3%)(p=0.0188)。同样，80岁以上组的MACE(主要不良心血管事件)发生率高于80岁组(p=0.0448)。出血(p=0.092)发生在年轻患者(9.3%)多于老年患者(0%)，而肾功能不全(p=0.0164)在老年患者(21.6%)高于年轻患者(7.8%)。老年患者的30天死亡率(21.6%)高于年轻患者(5.8%)(p=0.0045)。多变量分析显示，80岁以上患者早期死亡的优势比为2.9%(可信区间1.014-8.397)。两组术后5年内的晚期死亡率相似(80-组24.4%，80+组24.3%)。术后8项功能中有4项明显低于80+组。结论：接受AVR+CABG的80岁以上老年患者围术期并发症发生率较高，死亡率较高，但中期生存稳定。老年患者的围手术期并发症发生率高于年轻患者，术后身体功能方面的生活质量可以接受，但明显低于年轻患者。
Objective: Aim of the study was to answer the question whether the mortality and morbidity of octogenarians undergoing combined aortic valve replacement and myocardial revascularization (AVR + CABG) is higher than that of younger patients.Patients and methods: Between 01/1995 and 12/2002, 242 patients underwent AVR + CABG in our institution. 37 patients were older than 80 years (16 male, 21 female, median pressure gradient over the aortic valve: 53 mmHg, median EF: 62%), 205 patients were younger than 80 years (133 male, 72 female, median gradient 48 mmHg, median EF: 61%). NYHA class, aortic valve area and valve calcification were worse in the 80+ group. Biological valve prostheses were implanted in 94.6% of the older and in 45.4% of the younger patients (p < 0.001).Results: Perioperative complications occurred more often (p = 0.0188) in the 80+ group (86.5% experienced 1 or more complications) than in the 80-group (66.3%). Similarly, the MACE (Major Adverse Cardiovascular Events) rate was higher (p = 0.0448) in the 80+ group than in the 80-group. Bleeding occurred (p = 0.092) more often in younger (9.3%) than in older (0%) patients, while renal insufficiency was more frequent (p = 0.0164) in older (21.6%) than in younger patients (7.8%). The 30-day mortality was higher (p = 0.0045) in older (21.6%) than in younger patients (5.8%). Multivariate analysis revealed an odds ratio for early death of 2.9 (CI 1.014-8.397) for patients older than 80 years. The late death rate within the first 5 years after surgery was comparable in both groups (80- group 24.4%, 80+ group 24.3%). Postoperative quality of life was significantly worse in the 80+ group in 4 out of 8 functions.Conclusions: Octogenarians undergoing AVR + CABG have a relatively high perioperative complication rate and mortality, but show a stable medium-term survival. The perioperative complication rate is higher in older than in younger patients, and the postoperative quality of life with regard to bodily functions is acceptable but significantly worse than that of younger patients.