Sharony Ram, Grossi Eugene A, Saunders Paul C, Schwartz Charles F, Ribakove Greg H, Culliford Alfred T, Ursomanno Patricia, Baumann F Gregory, Galloway Aubrey C, Colvin Stephen B
Division of Cardiothoracic Surgery, New York University School of Medicine, New York, NY, USA.
Circulation. 2003 Sep 9;108 Suppl 1:II43-7. doi: 10.1161/01.cir.0000087446.53440.a3.
Although minimally invasive aortic valve surgery (MIAVR) is performed in many centers, few studies have compared its results to a standard sternotomy (SS) approach. We assessed the hypothesis that, when compared with SS in the elderly population, MIAVR has similar morbidity and mortality and allows faster hospital recovery.
From January 1995 through February 2002, 515 patients over age 65 underwent isolated aortic valve replacement. Using data gathered prospectively, 189 MIAVR patients were matched with 189 SS patients by age, ventricular function, valvular pathology, urgency of operation, diabetes, previous cardiac surgery, renal disease, and history of stroke. In each group, 56.1% of patients underwent non-elective procedures, and 28% were >or=80 years old. Hospital mortality (6.9%) and freedom from postoperative morbidity (82.5% versus 81.5%, P=0.79) were similar. Multivariate analysis revealed that urgent procedures [Odds Ratio (OR)=3.97; P=0.03], congestive heart failure (OR=3.94; P=0.03), and ejection fraction <30% (OR=4.16; P=0.03) were significant predictors of hospital mortality. Prolonged length of stay was associated with age (P=0.05), preoperative stroke (OR=3.5,P=0.001), CHF (OR=2.2, P=0.004), and sternotomy approach (OR=2.3,P=0.002) by multivariate analysis. More MIAVR patients were discharged home (52.6% versus 38.6%,P=0.03) rather than to rehabilitation facilities. Three year actuarial survival revealed no difference between groups.
Minimally invasive aortic valve surgery is safe in elderly patients, with morbidity and mortality comparable to sternotomy approach. The shorter hospital stay and greater percentage of patients discharged home after MIAVR reflect enhanced recovery with this technique.
尽管许多中心都开展了微创主动脉瓣手术（MIAVR），但很少有研究将其结果与标准胸骨切开术（SS）方法进行比较。我们评估了这样一个假设，即在老年人群中，与SS相比，MIAVR具有相似的发病率和死亡率，且能使患者更快地从医院康复。
从1995年1月至2002年2月，515例65岁以上患者接受了单纯主动脉瓣置换术。利用前瞻性收集的数据，将189例MIAVR患者与189例SS患者按年龄、心室功能、瓣膜病变、手术紧迫性、糖尿病、既往心脏手术史、肾脏疾病和中风史进行匹配。每组中，56.1%的患者接受了非择期手术，28%的患者年龄≥80岁。医院死亡率（6.9%）和术后无并发症发生率（82.5%对81.5%，P = 0.79）相似。多变量分析显示，急诊手术[比值比（OR）= 3.97；P = 0.03]、充血性心力衰竭（OR = 3.94；P = 0.03）和射血分数<30%（OR = 4.16；P = 0.03）是医院死亡率的显著预测因素。多变量分析显示，住院时间延长与年龄（P = 0.05）、术前中风（OR = 3.5，P = 0.001）、充血性心力衰竭（OR = 2.2，P = 0.004）和胸骨切开术式（OR = 2.3，P = 0.002）有关。更多的MIAVR患者出院回家（52.6%对38.6%，P = 0.03），而不是去康复机构。三年精算生存率显示两组之间无差异。
微创主动脉瓣手术在老年患者中是安全的，其发病率和死亡率与胸骨切开术式相当。MIAVR术后住院时间较短，出院回家的患者比例较高，这反映了该技术能促进患者康复。
