Guerra Miguel, Carlos Mota João
Serviço de Cirurgia Cardio-Torácica do Centro Hospitalar de Vila Nova de Gaia, Espinho.
Rev Port Cir Cardiotorac Vasc. 2008 Oct-Dec;15(4):189-93.
Over the past 20 years, there have been marked increased rates in cardiac surgery among the elderly in Portugal. To evaluate the effects of increasing age on outcome after cardiac surgery, 5652 patients who underwent cardiac surgery from 2003 to 2005 in five portuguese hospitals, were entered into a retrospective study. Patients were placed in five groups according to age: (1) 80 and older, (2) 70-79, (3) 60-69, (4) 50-59 or (5) less than 50. Selected variables included risk factors, cardiac status, preoperative hemodynamics and surgical procedures. In-hospital mortality was collected on all patients. The mean age was 64.7+/-11.6 years-old and younger patients were more often male than older patients (74.4% vs 51.9%). Preoperative COPD and peripheral vascular disease rates increased for those older than 60 years and decreased for those aged 30 to 49 years. Octogenarians had more congestive heart failure (62.5% vs 37.7%), urgent operations (39.2% vs 26.4%), aortic valve surgery (44.5% vs 26,8%) and off-pump CABG (77.8% vs 57.3%) than the younger groups. Hospital mortality was less than 2.0% in patients younger than 69 years-old, 3.5% in septuagenarians and 10,0%in octogenarians. While patients age at operation significantly influenced hospital mortality, this appeared to be a consequence of the increased frequency of risk factors and comorbidities together with decreased physiologic reserve in patients over 80 years of age.
在过去20年里，葡萄牙老年人心脏手术的发生率显著上升。为评估年龄增长对心脏手术后预后的影响，对2003年至2005年在葡萄牙五家医院接受心脏手术的5652例患者进行了一项回顾性研究。根据年龄将患者分为五组：（1）80岁及以上，（2）70 - 79岁，（3）60 - 69岁，（4）50 - 59岁或（5）小于50岁。选定的变量包括危险因素、心脏状况、术前血流动力学和手术方式。收集了所有患者的院内死亡率。平均年龄为64.7±11.6岁，年轻患者男性比例高于老年患者（74.4%对51.9%）。60岁以上患者术前慢性阻塞性肺疾病（COPD）和外周血管疾病发生率上升，30至49岁患者发生率下降。与年轻组相比，八旬老人有更多的充血性心力衰竭（62.5%对37.7%）、急诊手术（39.2%对26.4%）、主动脉瓣手术（44.5%对26.8%）和非体外循环冠状动脉旁路移植术（CABG）（77.8%对57.3%）。69岁以下患者的院内死亡率低于2.0%，七旬老人为3.5%，八旬老人为10.0%。虽然手术时患者年龄显著影响院内死亡率，但这似乎是80岁以上患者危险因素和合并症频率增加以及生理储备下降的结果。
