Levy Praschker Beltran G, Leprince Pascal, Bonnet Nicolas, Rama Akhtar, Bors Valéria, Lievre Laurance, Pavie Alain, Gandjbakhch Iradj
Department of Thoracic and Cardiovascular Surgery, Université Pierre et Marie Curie Paris VI, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hopitaux de Paris, 47-83, Boulevard del'Hôpital, 75651 Paris Cedex 13, France.
Interact Cardiovasc Thorac Surg. 2006 Dec;5(6):696-9. doi: 10.1510/icvts.2006.138255. Epub 2006 Sep 18.
Nonagenarians represent a growing part of the population. However, it is assumed that they present a poorer functional class to cope with the stress inferred by surgical interventions. The aim of this study was to review our experience with nonagenarians concerning postoperative morbidities, mortality, and long-term survival status. Retrospective data from 30 consecutive nonagenarians who underwent cardiac surgery between January 1990 and December 2002, and their long-term follow-up was analysed. There were 18 women (60%) and 11 men. Left ventricle ejection fraction (LVEF) was 50.3+/-10.5%. Fifty percent of the patients were in NYHA functional class III or IV. There were nine coronary artery bypass grafting (CABG) procedures (30%), 16 aortic valve replacements (AVR), (53%), one double valve procedure and one replacement of infected intracavitary pace-maker leads. In-hospital mortality rate was 20% (6/30). Mean follow-up was 21.5+/-19 months (r: 2.2 to 68). Actuarial survival rate at 12, 24 and 60 months was 67%, 43% and 30%, respectively. Surviving patients referred quality of life as good, all but one were in NYHA functional class I. Nonagenarians undergoing cardiac surgery have higher mortality and morbidity rates than younger patients. However, in a carefully selected group of patients, the operative risk remains acceptable.
九旬老人在人口中所占比例日益增加。然而，一般认为他们的功能状态较差，难以应对手术干预带来的压力。本研究的目的是回顾我们在九旬老人心脏手术方面有关术后发病率、死亡率及长期生存状况的经验。分析了1990年1月至2002年12月期间连续30例接受心脏手术的九旬老人的回顾性数据及其长期随访情况。其中有18名女性（60%）和11名男性。左心室射血分数（LVEF）为50.3±10.5%。50%的患者属于纽约心脏协会（NYHA）心功能Ⅲ级或Ⅳ级。有9例冠状动脉旁路移植术（CABG）（30%），16例主动脉瓣置换术（AVR）（53%），1例双瓣膜手术和1例感染性心腔内起搏器导线置换术。住院死亡率为20%（6/30）。平均随访时间为21.5±19个月（范围：2.2至68个月）。12个月、24个月和60个月时的精算生存率分别为67%、43%和30%。存活患者称生活质量良好，除1例患者外，其余均为NYHA心功能Ⅰ级。接受心脏手术的九旬老人的死亡率和发病率高于年轻患者。然而，在经过精心挑选的患者群体中，手术风险仍然可以接受。
