Gulbins H, Malkoc A, Ennker J
Department of Cardiac Surgery, Heart Institute Lahr, Lahr, Germany.
Clin Res Cardiol. 2008 Mar;97(3):176-80. doi: 10.1007/s00392-007-0615-8. Epub 2008 Jan 14.
The number of patients with an indication for cardiac surgery in their ninth decade of life is increasing. This study analyses the single-center results with combined and redo cardiac surgical procedures in octogenarians retrospectively.
Three groups were evaluated: (I) Two hundred and thirty six patients with combined cardiac surgical procedures, mean age 83.1 +/- 2.5 years, 107 male (129 female). Combined aortic valve replacement (AVR) and aorto coronary bypass (ACB) was done in 215, double valve replacement (DVR) in 21. (II) AVR + ACB-group: 215 patients out of group I. (III) Control group consisting of 124 patients with a mean age of 74.1 +/- 2.8 years (range 70-79.9 years) who received combined AVR and ACB. Risk stratification was done using the additive and logistic Euro-score; values are given as mean +/- standard deviation and were compared using either the t-test or the Chi-square test.
The observed mortality in group I was 9.3%. Re-intubation was observed in 10.2% and was one major risk factor for in-hospital mortality. As second risk factor, DVR could be identified. 14.8% required hemodialysis postoperatively, but this affected only the length of stay on intensive care unit (ICU) but not mortality. When comparing group II with group III, mortality was higher (10% vs. 4%), the need for hemodialysis was more frequent (16.3% vs. 4.9%), and the incidence of postoperative psycho-syndromes was also higher (26% vs. 8.1%, all: P < 0.05). The duration of ventilation (2.7 +/- 7.7 vs. 1.6 +/- 4.3 days) and the length of stay on ICU (8.2 +/- 8.8 vs. 5.7 +/- 6.4) were longer without reaching statistical significance (P > 0.05). The Euro-score overestimated the real mortality in all groups.
Octogenarians requiring combined cardiac surgical procedures required more resources and had a higher in-hospital mortality compared to younger patients. The observed in-hospital mortality was much lower than the predicted justifying the indication for surgical therapy in these patients. Patient selection, however, seems to be important but the Euro-score alone was rather ineffective in predicting poor outcome.
九十岁年龄段有心脏手术指征的患者数量正在增加。本研究回顾性分析了单中心八十岁以上老人进行联合及再次心脏手术的结果。
评估了三组患者：（I）236例接受联合心脏手术的患者，平均年龄83.1±2.5岁，男性107例（女性129例）。其中215例行主动脉瓣置换术（AVR）和主动脉冠状动脉搭桥术（ACB），21例行双瓣膜置换术（DVR）。（II）AVR+ACB组：I组中的215例患者。（III）对照组由124例平均年龄74.1±2.8岁（范围70 - 79.9岁）的患者组成，他们接受了AVR和ACB联合手术。使用相加性和逻辑欧洲评分进行风险分层；数值以平均值±标准差表示，并使用t检验或卡方检验进行比较。
I组观察到的死亡率为9.3%。再次插管发生率为10.2%，是院内死亡的一个主要危险因素。作为第二个危险因素，可以确定为DVR。14.8%的患者术后需要血液透析，但这仅影响重症监护病房（ICU）的住院时间，而不影响死亡率。将II组与III组进行比较时，II组死亡率更高（10%对4%），血液透析需求更频繁（16.3%对4.9%），术后精神综合征的发生率也更高（26%对8.1%，所有：P<0.05）。通气时间（2.7±7.7对1.6±4.3天）和ICU住院时间（8.2±8.8对5.7±6.4）更长，但未达到统计学显著性（P>0.05）。欧洲评分高估了所有组的实际死亡率。
与年轻患者相比，需要进行联合心脏手术的八十岁以上老人需要更多资源且院内死亡率更高。观察到的院内死亡率远低于预测值，证明了对这些患者进行手术治疗的合理性。然而，患者选择似乎很重要，但仅欧洲评分在预测不良结局方面相当无效。
