在健康的八旬老人中，冠状动脉搭桥术联合主动脉瓣置换术不会增加术后风险。

Coronary artery bypass grafting combined with aortic valve replacement in healthy octogenarians does not increase postoperative risk.

作者信息

Brunvand Harald, Offstad Jon, Nitter-Hauge Sigurd, Svennevig Jan Ludvig

机构信息

Department of Cardiology, Rikshospitalet, University of Oslo, Norway.

出版信息

Scand Cardiovasc J. 2002 Sep;36(5):297-301. doi: 10.1080/140174302320774519.

DOI:10.1080/140174302320774519

PMID:12470398

Abstract

OBJECTIVE

Critical aortic stenosis with or without coronary artery disease is increasingly common in octogenarians. Surgery is the treatment of choice, but indications and results of aortic valve replacement (AVR), particularly when combined with coronary artery bypass grafting (CABG) are debated. We investigated whether the combined procedure of AVR and CABG increased postoperative risk compared with isolated AVR in otherwise healthy octogenarians.

DESIGN

In the period 1994-1998, AVR was performed in 94 patients above 80 years, the majority in NYHA class III and IV. Combined AVR and CABG was performed in 52/94 patients. The patients were studied retrospectively by collecting data from hospital records and followed for 0-7 years.

RESULTS

Mean age was 82 +/- 2.3 years, sex (male/female) 33/61, left ventricular ejection fraction 70 +/- 18%, transvalvular peak pressure gradient 63 +/- 20 mmHg and aortic valve area 0.5 +/- 0.2 cm(2). Early mortality (< 30 days) was 4/42 (9.5%) after AVR and 4/52 (7.6%) after AVR and CABG (p = NS between groups). Three-year survival was 33/42 (78.5%) after AVR and 42/52 (80.7%) after AVR and CABG (p = NS between groups).

CONCLUSION

AVR with concomitant CABG in octogenarians with aortic stenosis who are otherwise healthy, may be performed without increased risk.

摘要

目的

伴有或不伴有冠状动脉疾病的严重主动脉瓣狭窄在八旬老人中越来越常见。手术是首选治疗方法，但主动脉瓣置换术（AVR）的适应证和结果，尤其是与冠状动脉旁路移植术（CABG）联合使用时，仍存在争议。我们研究了在其他方面健康的八旬老人中，AVR与CABG联合手术相比单纯AVR是否会增加术后风险。

设计

在1994年至1998年期间，对94例80岁以上患者进行了AVR手术，大多数患者为纽约心脏协会（NYHA）心功能Ⅲ级和Ⅳ级。94例患者中有52例接受了AVR与CABG联合手术。通过收集医院记录中的数据对患者进行回顾性研究，并随访0至7年。

结果

平均年龄为82±2.3岁，性别（男/女）为33/61，左心室射血分数为70±18%，跨瓣峰值压力梯度为63±20 mmHg，主动脉瓣面积为0.5±0.2 cm²。AVR术后早期死亡率（<30天）为4/42（9.5%），AVR与CABG联合手术后为4/52（7.6%）（组间p值无统计学意义）。AVR术后三年生存率为33/42（78.5%），AVR与CABG联合手术后为42/52（80.7%）（组间p值无统计学意义）。