慢性器质性二尖瓣反流瓣膜置换术后老年患者的生活质量

Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation.

作者信息

Maisano Francesco, Viganò Giorgio, Calabrese Chiara, Taramasso Maurizio, Denti Paolo, Blasio Andrea, Guidotti Andrea, Alfieri Ottavio

机构信息

Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milano, Italy.

出版信息

Eur J Cardiothorac Surg. 2009 Aug;36(2):261-6; discussion 266. doi: 10.1016/j.ejcts.2009.02.055. Epub 2009 Apr 15.

DOI:10.1016/j.ejcts.2009.02.055

PMID:19372045

Abstract

OBJECTIVE

Mitral valve surgery for organic mitral regurgitation (MR) in the elderly has been debated. In the elderly, quality of life is a better indicator of surgical success than survival. We assessed quality of life of elderly patients submitted to surgery for MR using the Minnesota Living with Heart Failure (MLHF) questionnaire.

METHODS

Between August 2003 and August 2006, 225 consecutive patients >70 years old underwent surgical treatment of organic MR. Mean age was 77 +/- 3.3 years (range 71-87 years). Mean EF was 50 +/- 11%. Degenerative disease was the most prevalent (77%) etiology. CABG was associated in 25% of patients. Mean Charlson score was 4.3 +/- 1.5 and 101 patients (45%) were NYHA class III and IV. Hospital survivors were followed up and quality of life by MLHF score was assessed.

RESULTS

Mitral repair and replacement were equally distributed in this population. Hospital mortality was 2.7%. Late survival was 91 +/- 1.9% at 3 years. MLHF was obtained from 204 patients at mean 2 +/- 1 years of follow-up. MLHF score was 38 +/- 18; there were 135 (66%) patients with MLHF >30. MLHF tended to increase with age at follow-up (p = 0.007). Multivariable predictors of MLHF were preoperative atrial fibrillation (p = 0.019), diabetes (p = 0.03), higher creatinine level (p = 0.0009), higher EuroSCORE (p = 0.02), residual mitral regurgitation grade at follow-up echocardiography (p < 0.0001) and systolic pulmonary artery pressure at follow-up (p = 0.04). Type of surgical treatment (repair vs replacement and choice of prosthesis) did not predict MLHF at follow-up, although those who had recurrent MR after repair had the highest scores compared to patients who had repair and durable result and those treated by replacement (MLHF was 51 +/- 21, vs 34 +/- 16, vs 39 +/- 18, respectively, p = 0.0013).

CONCLUSIONS

Quality of life following mitral valve surgery is suboptimal in more than half of elderly patients. MLHF score at follow-up is mostly related to preoperative conditions. Type of surgery does not influence MLHF score, however, quality of life is worse in patients with recurrent/residual MR following repair.

摘要

目的

老年患者器质性二尖瓣反流（MR）的二尖瓣手术一直存在争议。对于老年人，生活质量比生存率更能体现手术成功与否。我们使用明尼苏达心力衰竭生活问卷（MLHF）评估接受MR手术的老年患者的生活质量。

方法

2003年8月至2006年8月期间，225例连续的70岁以上患者接受了器质性MR的外科治疗。平均年龄为77±3.3岁（范围71 - 87岁）。平均射血分数（EF）为50±11%。退行性疾病是最常见的病因（77%）。25%的患者合并冠状动脉旁路移植术（CABG）。平均查尔森评分为4.3±1.5，101例患者（45%）为纽约心脏协会（NYHA）Ⅲ级和Ⅳ级。对医院幸存者进行随访，并通过MLHF评分评估生活质量。

结果

二尖瓣修复和置换在该人群中分布均匀。医院死亡率为2.7%。3年时的晚期生存率为91±1.9%。在平均随访2±1年时从204例患者中获得了MLHF评分。MLHF评分为38±18；135例（66%）患者的MLHF>30。随访时MLHF评分倾向于随年龄增加而升高（p = 0.007）。MLHF的多变量预测因素为术前心房颤动（p = 0.019）、糖尿病（p = 0.03）、较高的肌酐水平（p = 0.0009）、较高的欧洲心脏手术风险评估系统（EuroSCORE）评分（p = 0.02）、随访超声心动图时的残余二尖瓣反流分级（p < 0.0001）以及随访时的收缩期肺动脉压（p = 0.04）。手术治疗类型（修复与置换以及假体选择）在随访时并不能预测MLHF评分，不过，与修复后效果持久的患者以及接受置换治疗的患者相比，修复后出现复发性MR的患者评分最高（MLHF分别为51±21、34±16、39±18，p = 0.0013）。