动脉移植可降低八旬老人的手术死亡率，并提高其长期生活质量。
Arterial grafting results in reduced operative mortality and enhanced long-term quality of life in octogenarians.
作者信息
Kurlansky Paul A, Williams Donald B, Traad Ernest A, Carrillo Roger G, Schor John S, Zucker Melinda, Singer Sam, Ebra George
机构信息
Miami Heart Research Institute, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
出版信息
Ann Thorac Surg. 2003 Aug;76(2):418-26; discussion 427. doi: 10.1016/s0003-4975(03)00551-4.
BACKGROUND
Despite well-established benefits of arterial (ART) grafting, surgeons have been reluctant to use this conduit in octogenarians. This study explores the influence of arterial revascularization on operative and long-term outcomes of coronary artery bypass grafting surgery.
METHODS
A retrospective analysis was conducted of 987 consecutive patients 80 years of age or older who underwent isolated coronary artery bypass grafting between January 1989 and November 2000. Patients with saphenous vein graft only (SVG; n = 574) were compared with those receiving arterial and saphenous vein grafts (ART+SVG; n = 413). Mean follow-up for SVG patients was 3.8 years (range, 4 months to 12.6 years) and 98.6% complete, and mean follow-up was 3.1 years for ART+SVG patients (range, 2 months to 11.2 years) and 97.3% complete.
RESULTS
Patients with SVG had a significantly higher (p = 0.009) operative mortality (11.1% versus 6.3%) and significantly longer postoperative length of stay (12.9 versus 10.7 days; p = 0.002) than ART+SVG recipients. More ART+SVG than SVG patients were free of all postoperative complications (290 of 413; 70.2% versus 372 of 574; 64.8%; p = 0.086). Multivariable analysis identified SVG as an independent predictor of operative mortality (p = 0.014) and late mortality (p = 0.040). When patients were matched by equivalent propensity scores to receive SVG only, operative mortality was higher for SVG patients in four of the five quintiles. At 10 years, 97.0% +/- 1.2% of SVG and 92.9% +/- 3.7% of ART+SVG current survivors were free of all late major adverse cardiac events (p = 0.565), and 95.5% of SVG patients and 97.5% of ART+SVG patients were in Canadian class 1 or 2 (p = 0.162). On the SF-36 quality-of-life assessment, ART+SVG patients scored significantly higher than both SVG patients and age-adjusted normal subjects. Physical health summary component scores were 36.8 +/- 11.0 for SVG and 41.0 +/- 10.3 for ART+SVG (p = 0.001). Mental health summary scores were comparable for the two groups.
CONCLUSIONS
Arterial grafting confers an operative survival benefit, and an enhanced long-term quality of life in elderly patients.
背景
尽管动脉（ART）移植有公认的益处，但外科医生一直不愿在八旬老人中使用这种血管 conduit。本研究探讨动脉血运重建对冠状动脉旁路移植手术的手术及长期结局的影响。
方法
对1989年1月至2000年11月期间连续接受单纯冠状动脉旁路移植手术的987例80岁及以上患者进行回顾性分析。仅接受大隐静脉移植（SVG；n = 574）的患者与接受动脉和大隐静脉移植（ART+SVG；n = 413）的患者进行比较。SVG患者的平均随访时间为3.8年（范围4个月至12.6年），随访完整性为98.6%，ART+SVG患者的平均随访时间为3.1年（范围2个月至11.2年），随访完整性为97.3%。
结果
与ART+SVG接受者相比，SVG患者的手术死亡率显著更高（p = 0.009）（11.1%对6.3%），术后住院时间显著更长（12.9天对10.7天；p = 0.002）。无所有术后并发症的ART+SVG患者比SVG患者更多（413例中的290例；70.2%对574例中的372例；64.8%；p = 0.086）。多变量分析确定SVG是手术死亡率（p = 0.014）和晚期死亡率（p = 视情况修改040）的独立预测因素。当按等效倾向评分匹配患者仅接受SVG时，在五个五分位数中的四个中，SVG患者的手术死亡率更高。在10年时,当前存活的SVG患者中有97.0%±1.2%、ART+SVG患者中有92.9%±3.7%无所有晚期主要不良心脏事件（p = 0.565），95.5%的SVG患者和97.5%的ART+SVG患者处于加拿大1级或2级（p = 0.162）。在SF-36生活质量评估中，ART+SVG患者的得分显著高于SVG患者和年龄调整后的正常受试者。SVG患者的身体健康总结成分评分为36.8±11.0，ART+SVG患者为41.0±10.3（p = 0.001）。两组的心理健康总结评分相当。
结论
动脉移植可带来手术生存益处，并提高老年患者的长期生活质量。
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