Sundt T M, Bailey M S, Moon M R, Mendeloff E N, Huddleston C B, Pasque M K, Barner H B, Gay W A
Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
Circulation. 2000 Nov 7;102(19 Suppl 3):III70-4. doi: 10.1161/01.cir.102.suppl_3.iii-70.
The optimal management of aortic valve disease in patients >80 years old depends on functional outcome as well as operative risks and late survival.
We retrospectively identified 133 patients (62 men, 71 women) aged 80 to 91 years (mean 84+/-3 years) who underwent aortic valve replacement alone or in combination with another procedure between January 1, 1993, and April 31, 1998. Demographics included hypertension 68%, diabetes mellitus 17%, and history of stroke 11%. Operative (30 day) mortality rate was 11%. Urgent or emergent surgery, aortic insufficiency, and perioperative stroke or renal dysfunction were risk factors for operative death by multivariable analysis. Intensive care unit and total hospital length of stay were prolonged at 6.2 and 14.7 days, respectively. Late follow-up between July 1, 1998, and November 1, 1999, was 98% complete. Actuarial survival at 1 and 5 years was 80% and 55%, respectively. Predictors of late mortality were preoperative or perioperative stroke, chronic obstructive pulmonary disease, aortic stenosis, and postoperative renal dysfunction. The mean New York Heart Association functional class for 65 long-term survivors improved from 3.1 to 1.7. Quality of life assessed with the Medical Outcomes Study Short Form-36 was comparable to that predicted for the general population >75 years old.
Functional outcome after aortic valve replacement in patients >80 years old is excellent, the operative risk is acceptable, and the late survival rate is good. Surgery should not be withheld from the elderly on the basis of age alone.
80岁以上主动脉瓣疾病患者的最佳治疗方案取决于功能转归、手术风险及远期生存率。
我们回顾性纳入了1993年1月1日至1998年4月31日期间接受单纯主动脉瓣置换术或联合其他手术的133例患者（62例男性，71例女性），年龄80至91岁（平均84±3岁）。人口统计学特征包括高血压68%、糖尿病17%、有卒中病史11%。手术（30天）死亡率为11%。多变量分析显示，急诊或紧急手术、主动脉瓣关闭不全以及围手术期卒中或肾功能不全是手术死亡的危险因素。重症监护病房及总住院时间分别延长至6.2天和14.7天。1998年7月1日至1999年11月1日的远期随访完成率为98%。1年和5年的精算生存率分别为80%和55%。远期死亡的预测因素为术前或围手术期卒中、慢性阻塞性肺疾病、主动脉瓣狭窄及术后肾功能不全。65例长期存活者的纽约心脏协会心功能分级平均从3.1改善至1.7。采用医学结局研究简明健康调查量表-36评估的生活质量与预测的75岁以上普通人群相当。
80岁以上患者主动脉瓣置换术后功能转归良好，手术风险可接受，远期生存率良好。不应仅因年龄而拒绝为老年人手术。
