Hou S H, Chu S H, Hung C R, Tsai C H, Lin F Y, Wang S S
Department of Surgery, National Taiwan University Hospital, Taipei, R.O.C.
J Formos Med Assoc. 1992 Nov;91(11):1088-95.
With the progress of medical science, the scope of open heart surgery has expanded. From 1975 through 1987, we operated on 114 consecutive patients aged 65 years and over with the aid of a cardiopulmonary bypass in the Department of Surgery, National Taiwan University Hospital. The annual number of these elderly patients has increased gradually, reaching 6.4% of the annual open heart cases in 1987. Eighty-six of our 114 patients were males and 28 were females. Their ages ranged from 65 to 88 years with an average of 68.5 years. Overall, 65 patients (57%) were operated on for coronary artery disease and/or its associated lesions; 41 (36%), for valvular heart disease; six, for aortic dissection; two, for cardiac tumor; and one, for congenital pulmonary stenosis. One patient had combined coronary artery disease and aortic dissection. The mortality for isolated coronary artery bypass surgery was 12%; for single valvular surgery it was 11%. The complexity of the surgical procedure increased the operative mortality. The overall mortality was 23.6% (27/114), with subsequent death in 5.7% during an average of 25 months of follow-up. Because of the degeneration of organ-systems in elderly patients, and its frequent association with poor cardiac reserve and other medical problems, these elderly cardiac patients should be checked thoroughly before they are considered for open heart surgery. Our experience suggests that open heart surgery can be done in selected patients aged 65 years or older with acceptable risks. Age alone should not be an absolute contraindication to surgery, and clinical improvement is to be expected after surgery.
随着医学科学的进步，心脏直视手术的范围不断扩大。1975年至1987年期间，我们在台湾大学医学院附设医院外科，借助体外循环，连续为114例65岁及以上的患者进行了手术。这些老年患者的年手术例数逐渐增加，在1987年达到了每年心脏直视手术病例的6.4%。我们的114例患者中，86例为男性，28例为女性。他们的年龄在65岁至88岁之间，平均年龄为68.5岁。总体而言，65例患者（57%）接受手术治疗的病因是冠状动脉疾病和/或其相关病变；41例（36%）是瓣膜性心脏病；6例是主动脉夹层；2例是心脏肿瘤；1例是先天性肺动脉狭窄。1例患者同时患有冠状动脉疾病和主动脉夹层。单纯冠状动脉搭桥手术的死亡率为12%；单瓣膜手术的死亡率为11%。手术操作的复杂性增加了手术死亡率。总体死亡率为23.6%（27/114），在平均25个月的随访期间，后续死亡率为5.7%。由于老年患者器官系统的退化，以及其经常伴有心脏储备功能差和其他医疗问题，这些老年心脏病患者在考虑进行心脏直视手术前应进行全面检查。我们的经验表明，在选定的65岁及以上患者中，进行心脏直视手术的风险是可以接受的。年龄本身不应成为手术的绝对禁忌证，术后有望实现临床改善。
