组织瓣膜与机械瓣膜：八旬老人的生活质量

Tissue versus mechanical prostheses: quality of life in octogenarians.

作者信息

Vicchio Mariano, Della Corte Alessandro, De Santo Luca Salvatore, De Feo Marisa, Caianiello Giuseppe, Scardone Michelangelo, Cotrufo Maurizio

机构信息

Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, Naples, Italy.

出版信息

Ann Thorac Surg. 2008 Apr;85(4):1290-5. doi: 10.1016/j.athoracsur.2007.12.039.

DOI:10.1016/j.athoracsur.2007.12.039

PMID:18355512

Abstract

BACKGROUND

The aim of this study was to determine whether changes in prognosis and quality of life (QOL) after aortic valve replacement (AVR) in octogenarians differ depending on the choice of mechanical (MP) or tissue (BP) valves.

METHODS

Between July 1992 and September 2006, 160 consecutive octogenarians underwent AVR with (18.8%) or without concomitant coronary artery bypass grafting. At follow-up (mean 3.4 +/- 2.8 years, 552 patient-years, 98.3% complete), 121 were still alive and answered the Medical Outcomes Study Short-Form 36 Health Survey (SF-36) QOL questionnaire.

RESULTS

Group BP had 62 patients. Group MP had 98 patients. Preoperative risk factors were comparable except group BP was older. Global hospital mortality was 8.8%. There were 21 late deaths, 61.9% of which were not valve- or anticoagulation-related. A significant difference emerged in 1-, 3-, 5- and 8-year actuarial survival rates (BP: 86.4% +/- 0.04%, 76.9% +/- 0.06%, 58.1% +/- 0.1%, 46.5% +/- 0.14%, respectively, vs MP: 91.3% +/- 0.03%, 88.6% +/- 0.03%, 81.6% +/- 0.05%, 70% +/- 0.67%; p = 0.025) but not in terms of 8-year freedom from valve-related complications (82.6% +/- 0.1% vs 87% +/- 0.053%, p = 0.55). One anticoagulant-related hemorrhage occurred in group MP; one stroke occurred in group BP. Survivors had significant improvement in New York Heart Association functional class compared with preoperatively (1.1 vs 2.8, p < 0.001) Mean QOL scores were satisfactory and substantially comparable between the two groups; in seven domains, scores were higher than those of the age- and sex-matched general Italian population.

CONCLUSIONS

Long-term survival after AVR in selected octogenarians was similar to that of the general elderly population. The device type exerted no influence on QOL.

摘要

背景

本研究旨在确定老年患者主动脉瓣置换术（AVR）后，根据机械瓣膜（MP）或生物瓣膜（BP）的选择不同，其预后和生活质量（QOL）的变化是否存在差异。

方法

1992年7月至2006年9月期间，160例连续的老年患者接受了AVR手术，其中部分患者（18.8%）同时进行了冠状动脉旁路移植术。在随访时（平均3.4±2.8年，552患者年，98.3%完整随访），121例患者仍存活，并回答了医学结局研究简表36健康调查（SF-36）QOL问卷。

结果

BP组有62例患者。MP组有98例患者。术前危险因素具有可比性，只是BP组患者年龄更大。总体医院死亡率为8.8%。有21例晚期死亡，其中61.9%与瓣膜或抗凝无关。1年、3年、5年和8年的精算生存率出现显著差异（BP组分别为86.4%±0.04%、76.9%±0.06%、58.1%±0.1%、46.5%±0.14%，MP组分别为91.3%±0.03%、88.6%±0.03%、81.6%±0.05%、70%±0.67%；p = 0.025），但在8年无瓣膜相关并发症方面无差异（82.6%±0.1%对87%±0.053%，p = 0.55）。MP组发生1例抗凝相关出血；BP组发生1例中风。与术前相比，存活患者的纽约心脏协会功能分级有显著改善（1.1对2.8，p < 0.001）。平均QOL评分令人满意，两组之间基本相当；在七个领域，评分高于年龄和性别匹配的意大利普通人群。