Antunes P E, Franco C G, Oliveira J F, Antunes M J
Serviço de Cirurgia Cardiotorácica, Hospitais da Universidade, Coimbra.
Rev Port Cardiol. 2001 May;20 Suppl 5:V-171-6; discussion V-177-8.
Previous reports on coronary artery bypass grafting in elderly patients have not usually addressed the current era of aggressive percutaneous angioplasty. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older from May 1988 to August 1993, 158 consecutive patients in this age range (mean age 70.3 years) underwent surgical revascularization at our institution. Overall operative mortality was 4.4% (7/158), with 71.4% (5/7) of deaths due to cardiac causes. Postoperative morbidity occurred in 50.6% (80/158) of patients but was of a serious nature in only 12.0% (19/158). Surgical priority was significantly correlated with operative mortality: 1.6% (2/122) for elective cases and 17.2% (5/29) for urgent or emergency cases (p < 0.01). Univariate analysis isolated the need for postoperative inotropic support or mechanical assistance, perioperative myocardial infarction and reoperation for bleeding as significant risk factors for operative mortality (p < 0.01). Of the patients discharged from the hospital, 144 (95.4%) were followed up for a mean of 23 months (3-62). During the follow-up period there were 3 deaths, all from non cardiac causes, and 92.3% of the patients were in Canadian Cardiovascular Society class I (CCS). These results indicate that, although with somewhat higher morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting, particularly if elective revascularization is possible.
以往关于老年患者冠状动脉旁路移植术的报道通常未涉及当前积极开展经皮血管成形术的时代背景。为了研究这一重要的患者亚组，我们分析了1988年5月至1993年8月期间本院70岁及以上患者近期冠状动脉旁路移植术的经验。在此年龄范围内的158例连续患者（平均年龄70.3岁）在本院接受了手术血运重建。总体手术死亡率为4.4%（7/158），其中71.4%（5/7）的死亡归因于心脏原因。术后并发症发生率为50.6%（80/158），但严重并发症仅占12.0%（19/158）。手术优先级与手术死亡率显著相关：择期手术为1.6%（2/122），急诊或紧急手术为17.2%（5/29）（p<0.01）。单因素分析确定术后需要使用正性肌力支持或机械辅助、围手术期心肌梗死以及因出血而再次手术是手术死亡的重要危险因素（p<0.01）。出院患者中，144例（95.4%）接受了平均23个月（3 - 62个月）的随访。随访期间有3例死亡，均为非心脏原因，92.3%的患者处于加拿大心血管学会I级（CCS）。这些结果表明，尽管发病率和死亡率略高，但在当前高风险冠状动脉旁路移植术时代，老年患者的手术风险是可以接受的，特别是如果能够进行择期血运重建。
