Chukwuemeka Andrew, Borger Michael A, Ivanov Joan, Armstrong Susan, Feindel Christopher M, David Tirone E
Division of Cardiovascular Surgery, Toronto General Hospital, Ontario, Canada.
J Heart Valve Dis. 2006 Mar;15(2):191-6; discussion 196.
The number of octogenarians is increasing in industrialized societies, and many patients aged over 80 years have heart valve disease which is amenable to surgical treatment. The perioperative outcomes and long-term results in very elderly patients undergoing valve surgery were evaluated.
A retrospective analysis was conducted of 2,791 patients with long-term follow up, who underwent valve surgery between 1990 and 2002. Of these patients, 132 (68 males, 64 females) were aged over 80 years (mean age 82 +/- 2 years; range: 80-94 years).
Ninety-five patients (71.9%) underwent aortic valve replacement, 36 (27.3%) mitral surgery, and one patient had double-valve surgery. Sixty-five patients (49.2%) required concomitant coronary artery bypass grafting. There were 11 (8.3%) redo procedures. Patients aged over 80 years were significantly more symptomatic preoperatively than their younger counterparts (NYHA class III-IV 90.9% versus 69.0%, p < 0.001), with more congestive cardiac failure, hypertension, peripheral vascular disease, obstructive pulmonary disease, and renal failure (all p < 0.05). Perioperative mortality did not, however, differ significantly between groups (< 80 years versus > or = 80 years, 2.9% versus 4.6%, p = 0.10). There was also no difference in the composite end point of in-hospital death, renal failure, stroke, low output state, myocardial infarction, or sternal wound infection (< 80 years versus > or = 80 years, 10.5% versus 11.4%, p = 0.8). The mean follow up period was 66 +/- 44 months (< 80 years) versus 61 +/- 37 (> or = 80 years). Late mortality was higher in the elderly group (10-year survival 37.9% versus 68.2%, p < 0.001) and preoperative atrial fibrillation (RR 2.75; CI: 1.44-5.23), coronary artery disease (RR 1.98; CI 1.12-3.52) and congestive cardiac failure (RR 2.13; CI: 1.10-4.11) were independent predictors of late mortality. The groups did not differ with respect to long-term valve-related events, with the exception of fewer reoperations among elderly patients.
Valve surgery in selected octogenarians is associated with low morbidity and mortality. The outlook after surgery is very good, and surgery should not be denied to this group on the basis of age alone.
在工业化社会中，八旬老人的数量不断增加，许多80岁以上的患者患有适合手术治疗的心脏瓣膜疾病。本研究评估了高龄患者接受瓣膜手术的围手术期结局和长期结果。
对1990年至2002年间接受瓣膜手术且进行长期随访的2791例患者进行回顾性分析。其中，132例（男68例，女64例）年龄超过80岁（平均年龄82±2岁；范围：80 - 94岁）。
95例（71.9%）患者接受主动脉瓣置换术，36例（27.3%）接受二尖瓣手术，1例接受双瓣膜手术。65例（49.2%）患者需要同期进行冠状动脉旁路移植术。有11例（8.3%）再次手术。80岁以上患者术前症状明显比年轻患者更多（纽约心脏协会心功能分级III - IV级分别为90.9%和69.0%，p < 0.001），充血性心力衰竭、高血压、外周血管疾病、阻塞性肺疾病和肾衰竭的发生率更高（均p < 0.05）。然而，围手术期死亡率在两组间无显著差异（<80岁组与≥80岁组，分别为2.9%和4.6%，p = 0.10）。住院死亡、肾衰竭、中风、低心排血量状态、心肌梗死或胸骨伤口感染的复合终点在两组间也无差异（<80岁组与≥80岁组，分别为10.5%和11.4%，p = 0.8）。平均随访时间<80岁组为66±44个月，≥80岁组为61±37个月。老年组晚期死亡率更高（10年生存率分别为37.9%和68.2%，p < 0.001），术前心房颤动（相对危险度2.75；可信区间：1.44 - 5.23）、冠状动脉疾病（相对危险度1.98；可信区间1.12 - 3.52）和充血性心力衰竭（相对危险度2.13；可信区间：1.10 - 4.11）是晚期死亡的独立预测因素。除老年患者再次手术较少外，两组在长期瓣膜相关事件方面无差异。
特定八旬老人行瓣膜手术的发病率和死亡率较低。术后前景良好，不应仅因年龄而拒绝为该组患者进行手术。
