老年患者的心脏手术——一种合适的手术方式？641例80岁以上患者的12年手术及术后死亡率

Cardiac surgery for octogenarians--a suitable procedure? Twelve-year operative and post-hospital mortality in 641 patients over 80 years of age.

作者信息

Schmidtler F W, Tischler I, Lieber M, Weingartner J, Angelis I, Wenke K, Kemkes B M, Gansera B

机构信息

Department of Cardiovascular Surgery, City Hospital Munich, Munich, Germany.

出版信息

Thorac Cardiovasc Surg. 2008 Feb;56(1):14-9. doi: 10.1055/s-2007-965642.

DOI:10.1055/s-2007-965642

PMID:18200461

Abstract

OBJECTIVES

The increase in life expectancy as a result of therapeutic improvements subsequently leads to a large number of patients with advanced age. The aim of this study was to review the 30-day mortality and mid-term outcome of octogenarians undergoing coronary artery bypass grafting (CABG) or valve replacement (AVR/MVR).

METHODS

The data of 641 patients with a mean age of 82.6 years (range 80.0 - 92.6), operated between 9/93 and 12/05, were reviewed. 432 patients underwent CABG, 188 had AVR and 21 had MVR. We analysed peri-/postoperative mortality and clinical outcomes. Follow-up was obtained by phone contact with patients or their physician. Mid-term survival was determined for the whole population by the Kaplan-Meier method; peri- and postoperative risk factor analysis was done using logistic regression. Follow-up ranged from 0.1 to 11.8 years (mean 3.6 +/- 2.6) and was complete for 99%.

RESULTS

We observed a perioperative mortality of 8.8% for CABG, 4.8% for AVR and 9.5% for MVR. Perioperative mortality was strongly associated with urgent/emergent operations (P < 0.03), poorer clinical status (P < 0.03), renal dysfunction (P < 0.05) and male gender (P < 0.04). Actuarial survival after 3, 5 and 8 years was as follows: CABG 78%, 66% and 44%; AVR 79%, 68% and 38%; MVR 76%, 61% and 23%. The mean NYHA functional class for survivors improved in the group of patients with CABG from 2.7 to 2.0 (P < 0.03), in the AVR group from 2.8 to 2.0 (P < 0.03), and in the MVR group from 2.9 to 2.3 (P < 0.05). More than 80% of all surviving patients live at home, either alone or with their family.

CONCLUSION

In our cohort of octogenarians, cardiac surgery was found to be associated with an acceptable, although increased perioperative mortality. Despite the enhanced perioperative risk, the clinical benefit, as verified by improved functional status and satisfactory mid-term survival rates, justifies surgery in these patients with advanced age.

摘要

目的

治疗水平的提高使得预期寿命增加，进而导致大量高龄患者的出现。本研究旨在回顾接受冠状动脉旁路移植术（CABG）或瓣膜置换术（AVR/MVR）的八旬老人的30天死亡率和中期预后。

方法

回顾了641例平均年龄82.6岁（范围80.0 - 92.6岁）、于1993年9月至2005年12月期间接受手术的患者的数据。432例患者接受了CABG，188例进行了AVR，21例进行了MVR。我们分析了围手术期/术后死亡率及临床结局。通过与患者或其医生电话联系进行随访。采用Kaplan-Meier法确定整个人群的中期生存率；使用逻辑回归进行围手术期和术后危险因素分析。随访时间为0.1至11.8年（平均3.6 +/- 2.6年），99%的随访完整。

结果

我们观察到CABG的围手术期死亡率为8.8%，AVR为4.8%，MVR为9.5%。围手术期死亡率与急诊/紧急手术（P < 0.03）、较差的临床状态（P < 0.03）、肾功能不全（P < 0.05）及男性性别（P < 0.04）密切相关。3年、5年和8年的精算生存率如下：CABG分别为78%、66%和44%；AVR分别为79%、68%和38%；MVR分别为76%、61%和23%。CABG组存活患者的平均纽约心脏协会（NYHA）功能分级从2.7改善至2.0（P < 0.03），AVR组从2.8改善至2.0（P < 0.03），MVR组从2.9改善至2.3（P < 0.05）。所有存活患者中超过80%居家生活，或独自居住或与家人同住。