欧洲心脏手术风险评估系统（EuroSCORE）可预测瓣膜置换术与冠状动脉搭桥术联合手术后的中期结果。

EuroSCORE predicts mid-term outcome after combined valve and coronary bypass surgery.

作者信息

Kasimir Marie-Theres, Bialy Jan, Moidl Reinhard, Simon-Kupilik Natascha, Mittlböck Martina, Hiesmayr Michael, Wolner Ernst, Simon Paul

机构信息

Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care, University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.

出版信息

J Heart Valve Dis. 2004 May;13(3):439-43.

PMID:15222291

Abstract

BACKGROUND AND AIM OF THE STUDY

EuroSCORE is widely used to assess operative risk. Combined cardiac procedures carry increased perioperative mortality, but the influence of preoperative factors on mid-term outcome is not well known for these patients. The study aim was to determine if EuroSCORE risk influences mid-term survival after combined coronary artery bypass grafting (CABG) and valve surgery.

METHODS

Follow up (mean 23.7 months) was obtained in 258 consecutive hospital survivors (148 males, 110 females; median age 72.29 years; mean EuroSCORE 7 points) operated on between January 1998 and March 2001. CABG + aortic valve replacement (AVR) was performed in 171 patients, CABG + mitral surgery in 72, and CABG + double valve surgery in 15. Kaplan-Meier estimates were calculated for survival and combined freedom from death and NYHA class III/IV. The Cox regression model was applied to prove the influence of EuroSCORE risk and a number of preoperative and operative variables on mid-term outcome.

RESULTS

Thirty patients (11.63%) died during follow up, and 34 (13.17%) were in NYHA class III/IV. Freedom from death and NYHA class III/IV was 89.3%, 74.7% and 55.2% at 12, 24 and 36 months, respectively. The significant predictor for combined death and NYHA class III/IV was EuroSCORE risk (p = 0.0004). In the subgroup of patients with CABG + mitral valve surgery, age was identified as a significant risk factor for death (p = 0.0346), whereas in the subgroup of patients with CABG + AVR EuroSCORE was detected as significant risk factor for combined death and NYHA class III/IV.

CONCLUSION

EuroSCORE is an important predictor for poor mid-term outcome after combined CABG and valve surgery.

摘要

研究背景与目的

欧洲心脏手术风险评估系统（EuroSCORE）被广泛用于评估手术风险。心脏联合手术的围手术期死亡率有所增加，但术前因素对这些患者中期预后的影响尚不明确。本研究的目的是确定EuroSCORE风险是否会影响冠状动脉旁路移植术（CABG）和瓣膜手术联合后的中期生存率。

方法

对1998年1月至2001年3月间连续手术的258例住院存活患者（148例男性，110例女性；年龄中位数72.29岁；EuroSCORE平均为7分）进行随访（平均23.7个月）。171例患者接受了CABG + 主动脉瓣置换术（AVR），72例接受了CABG + 二尖瓣手术，15例接受了CABG + 双瓣膜手术。计算Kaplan-Meier生存估计值以及死亡和纽约心脏协会（NYHA）III/IV级联合无事件生存率。应用Cox回归模型来证明EuroSCORE风险以及一些术前和手术变量对中期预后的影响。

结果

随访期间有30例患者（11.63%）死亡，34例（13.17%）处于NYHA III/IV级。12、24和36个月时死亡和NYHA III/IV级联合无事件生存率分别为89.3%、74.7%和55.2%。死亡和NYHA III/IV级联合的显著预测因素是EuroSCORE风险（p = 0.0004）。在CABG + 二尖瓣手术患者亚组中，年龄被确定为死亡的显著危险因素（p = 0.0346），而在CABG + AVR患者亚组中，EuroSCORE被检测为死亡和NYHA III/IV级联合的显著危险因素。