Maleszka Ariane, Kleikamp Georg, Zittermann Armin, Serrano Maria R G, Koerfer Reiner
Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North-Rhine Westfalia, University Hospital of Ruhr University Bochum, Bad Oeynhausen, Germany.
Ann Thorac Surg. 2008 Dec;86(6):1804-8. doi: 10.1016/j.athoracsur.2008.07.116.
Few reliable data are available on clinical outcome of octogenarians undergoing simultaneous aortic and mitral valve replacement.
We performed a retrospective analysis of 55 patients aged 80 years and over with double valve replacement who were operated on at our institution between 2001 and 2005. Thirty-day mortality and 1-year survival were assessed.
For most of the patients, stenosis was the cause of aortic valve surgery, whereas regurgitation was the cause of mitral valve replacement in the majority of patients. In one third of the patients, cardiac surgery had to be performed on an urgent/emergency basis. A large number of patients had concomitant diagnoses such as atrial fibrillation (73%), coronary artery disease (44%), renal insufficiency (29%), chronic obstructive pulmonary disease (20%), and diabetes mellitus (15%). In total, 16 patients (29%) died during follow-up. Survival rates at 30 days and 1 year were 91% and 71%, respectively. As determined by multivariable logistic regression analysis, Karnofsky performance status (hazard ratio: 0.899 per % increase; 95% confidence interval: 0.811 to 0.996; p = 0.043) and bypass time (hazard ratio: 1.062 per min; 95% confidence interval: 1.006 to 1.120; p = 0.028) were independent predictors of 30-day mortality. Beside these factors, additional independent predictors of 1-year mortality were preoperative stroke and postoperative intestinal failure (p = 0.008 and 0.003, respectively).
Our data demonstrate that, for selected octogenarians, double valve replacement can be performed with acceptable outcome. A better performance status of the patients at the time of cardiac surgery will probably improve 1-year survival.
关于八旬老人同期进行主动脉瓣和二尖瓣置换术的临床结果，可靠数据较少。
我们对2001年至2005年在我院接受双瓣置换术的55例80岁及以上患者进行了回顾性分析。评估了30天死亡率和1年生存率。
对于大多数患者，主动脉瓣手术的原因是狭窄，而二尖瓣置换的原因在大多数患者中是反流。三分之一的患者必须进行急诊/紧急心脏手术。大量患者伴有心房颤动（73%）、冠状动脉疾病（44%）、肾功能不全（29%）、慢性阻塞性肺疾病（20%）和糖尿病（15%）等诊断。总共16例患者（29%）在随访期间死亡。30天和1年的生存率分别为91%和71%。多变量逻辑回归分析确定，卡诺夫斯基功能状态（风险比：每增加1%为0.899；95%置信区间：0.811至0.996；p = 0.043）和体外循环时间（风险比：每分钟1.062；95%置信区间：1.006至1.120；p = 0.028）是30天死亡率的独立预测因素。除这些因素外，1年死亡率的其他独立预测因素是术前中风和术后肠衰竭（分别为p = 0.008和0.003）。
我们的数据表明，对于选定的八旬老人，双瓣置换术可以取得可接受的结果。心脏手术时患者更好的功能状态可能会提高1年生存率。
