Septuagenarians with hypertrophic obstructive cardiomyopathy undergoing myectomy: the experience of a single center.
Septuagenarians with hypertrophic obstructive cardiomyopathy undergoing myectomy: the experience of a single center.
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患有肥厚性梗阻性心肌病的七十多岁老人接受心肌切除术：单一中心的经验。
DOI：
10.1007/s00595-021-02272-y
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发表时间：
2021
期刊：
影响因子：
2.5
通讯作者：
Wang ChunSheng
中科院分区：
文献类型：
--
作者：
Ji Qiang;Wang YuLin;Yang Ye;Xia LiMin;Qi XiaoMin;Wang ChunSheng
先前的一项研究报道，老年患者的室间隔更脆弱，因此脊髓切除术可能使老年患者面临更高的严重并发症风险。本单中心研究评估高龄对症状性肥厚性梗阻性心肌病（HOCM）肌瘤切除术后结果的影响。方法将所有符合条件的患者分为老年组（70岁以上，n= 35）和对照组（70岁以下，n= 197）。患者随访时间中位数为10个月。比较围手术期和随访结果。结果13例患者（老年组为8.6%，对照组为5.1%,p= 0.422）立即再次行手术治疗。手术死亡率组间无差异（0 vs. 0.5%,p < 0.05）。两组间完全房室传导阻滞发生率差异无统计学意义（5.7 vs 3.0%,p= 0.346）。两组随访均未发生死亡。两组最新随访时的最大梯度均显著低于术前值。此外，分组（70岁老人vs. 70岁以下患者）不是手术并发症和多变量logistic回归结果的独立危险因素。结论70岁以下HOCM患者行鼻中隔肌切除术，与70岁以下HOCM患者相同，可获得良好的治疗效果。
PurposesA previous study reported that the ventricular septum is more fragile in geriatric patients, and thus myectomy may expose geriatric patients to a higher risk of serious complications. This single-center study evaluates the impacts of the advanced age on the results following myectomy for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).MethodsAll eligible patients were divided into an elderly group (septuagenarians,n= 35) and a control group (patients under 70 years,n= 197). The patients were followed up for a median of 10 months. Thereafter, the perioperative and follow-up results were compared.ResultsThirteen patients (8.6% for the elderly group and 5.1% for the control group,p= 0.422) underwent immediate repeat surgery. Surgical mortality did not differ between groups (0 vs. 0.5%,p> 0.05). There was no significant difference in the incidence of complete atrioventricular block between groups (5.7 vs. 3.0%,p= 0.346). No follow-up deaths occurred in either group. The maximum gradients at the latest follow-up were significantly lower than the preoperative values in either group. Additionally, grouping (septuagenarians vs. patients under 70 years of age) was not an independent risk factor for surgical complications and results via multivariable logistic regression.ConclusionsSeptuagenarians with HOCM may obtain favorable results following septal myectomy, the same as did HOCM patients under 70 years of age.