Kiblawi Fuad M, Sommer Robert J, Levchuck Sean G
Division of Pediatric Cardiology, St. Joseph Children's Hospital, Paterson, NJ 07503, USA.
Catheter Cardiovasc Interv. 2006 Jul;68(1):136-42; discussion 143-4. doi: 10.1002/ccd.20722.
Comparing results of patent foramen ovale (PFO) closure in older and younger patient cohorts.
The literature pertaining to stroke and PFO has focused on patients <55 years of age.
Between March 2000 and December 2003, 456 consecutive stroke/transient ischemic attack (TIA) patients (14.2-91.1 years, mean 51.4 +/- 15.5) underwent successful closure of PFO with a CardioSEAL Septal Occluder by one operator at five hospitals. Of the 456 patients, 184 (40.4%) were >55 years of age at the time of the procedure (mean 66.9 +/- 8.3 years) and comprise the subject group (OLDER). The remaining 272 patients (mean 41.1 +/- 7.7) comprise the control group (YOUNGER). Data were collected prospectively in a registry type format.
Minor procedural complications were comparable: 7/184 (3.8%) OLDER vs. 12/272 (4.4%) YOUNGER (P = NS). In the follow-up period (1-45 months, mean = 17.8 +/- 11.1), there was no significant difference in the rate of recurrent stroke/TIA, headaches, or late unrelated death. Forty OLDER patients and 47 YOUNGER developed new onset atrial arrhythmia (P = NS). The incidence of new onset atrial fibrillation (AF), however, was significantly higher in OLDER (14/40 OLDER and only 2/47 YOUNGER, P < 0.025). All patients who were in normal sinus rhythm (NSR) before the procedure are in NSR at last follow-up.
Older patients should not be excluded from PFO closure. The procedure seems as safe and effective in preventing recurrent stroke in the older, as in the younger population. Older patients seem more prone to developing AF.
比较老年和年轻患者队列中卵圆孔未闭（PFO）封堵术的结果。
有关中风与PFO的文献主要关注年龄小于55岁的患者。
在2000年3月至2003年12月期间，456例连续的中风/短暂性脑缺血发作（TIA）患者（年龄14.2 - 91.1岁，平均51.4±15.5岁）在五家医院由一名操作者使用CardioSEAL房间隔封堵器成功进行了PFO封堵。在这456例患者中，184例（40.4%）在手术时年龄大于55岁（平均66.9±8.3岁），构成研究组（老年组）。其余272例患者（平均41.1±7.7岁）构成对照组（年轻组）。数据以前瞻性登记的形式收集。
轻微手术并发症相当：老年组184例中有7例（3.8%），年轻组272例中有12例（4.4%）（P = 无显著性差异）。在随访期（1 - 45个月，平均 = 17.8±11.1），复发性中风/TIA、头痛或晚期非相关性死亡的发生率无显著差异。40例老年患者和47例年轻患者出现新发房性心律失常（P = 无显著性差异）。然而，新发房颤（AF）的发生率在老年组显著更高（老年组40例中有14例，年轻组47例中仅2例，P < 0.025）。所有术前处于正常窦性心律（NSR）的患者在最后一次随访时仍为NSR。
老年患者不应被排除在PFO封堵术之外。该手术在预防老年患者复发性中风方面似乎与年轻人群一样安全有效。老年患者似乎更容易发生房颤。
