Azariades M, Fessler C L, Ahmad A, Starr A
Heart Institute, St Vincent Hospital and Medical Center, Oregon Health Sciences University, Portland.
Eur J Cardiothorac Surg. 1991;5(7):373-7. doi: 10.1016/1010-7940(91)90055-o.
Elderly patients who develop symptomatic aortic valvular malfunction have a grave prognosis. Until recently they have not been seriously considered for active treatment, such as valvular surgery or balloon valvuloplasty. Between January 1972 and July 1989, 88 patients over the age of 80 years underwent aortic valve replacement and have been prospectively followed for a total of 185 patient-years. The majority were in New York Heart Association functional class III (48%) or IV (48%) preoperatively. Valvular pathology was pure aortic stenosis in 81%, regurgitation alone in 6%, and mixed lesions in 13% of the cases. Before 1982 the majority of patients received mechanical valves, whereas tissue valves have predominated since then (76% of total). Forty-three percent of the patients had concomitant coronary artery bypass grafting. The overall operative mortality was 16%. Emergency surgery, isolated aortic valve replacement, advanced preoperative functional class, and female gender carried a statistically higher operative mortality. The overall actuarial survival (standard error) at 5 years was 64(7)%. Survival was significantly higher at 5 years for concomitant coronary bypass grafting than for isolated aortic valve replacement, 70 (11)% versus 59(8%), and for males compared to females, 73(9)% versus 55(9)%. The 5-year event-free rates for valve-related death and valve re-replacement were 97(2)% and 93(5)%, respectively. These data provide a firm basis for aortic valve replacement as the standard form of treatment in patients over 80.
出现有症状的主动脉瓣功能障碍的老年患者预后严重。直到最近，他们还未被认真考虑进行积极治疗，如瓣膜手术或球囊瓣膜成形术。在1972年1月至1989年7月期间，88例80岁以上的患者接受了主动脉瓣置换术，并进行了前瞻性随访，总计185患者年。大多数患者术前纽约心脏协会心功能分级为III级（48%）或IV级（48%）。瓣膜病变情况为单纯主动脉瓣狭窄的占81%，单纯反流的占6%，混合病变的占13%。1982年前，大多数患者接受机械瓣膜，此后组织瓣膜占主导（占总数的76%）。43%的患者同时进行了冠状动脉旁路移植术。总体手术死亡率为16%。急诊手术、单纯主动脉瓣置换、术前心功能分级较高以及女性患者的手术死亡率在统计学上更高。5年时的总体精算生存率（标准误差）为64（7）%。同时进行冠状动脉旁路移植术的患者5年生存率显著高于单纯主动脉瓣置换患者，分别为70（11）%和59（8）%，男性患者的生存率高于女性患者，分别为73（9）%和55（9）%。瓣膜相关死亡和瓣膜再次置换的5年无事件发生率分别为97（2）%和93（5）%。这些数据为80岁以上患者将主动脉瓣置换作为标准治疗方式提供了坚实依据。
