Suojaranta-Ylinen Raili T, Soisalon-Soininen Sari, Kaartinen Maija, Maasilta Paula K, Vainikka Tiina L, Vento Antti E, Salminen Ulla-Stina
Department of Anesthesia and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
J Heart Valve Dis. 2009 Sep;18(5):514-23.
Today, the elderly population continues to increase worldwide, and rates of aortic stenosis (AS) climb with age. Since aortic valve replacement (AVR) is the current treatment for elderly patients with symptomatic AS, the number of patients undergoing AVR is expected to grow.
Among patients operated on at Helsinki University Hospital between 1992 and 1997, a cohort (n = 145) was followed after AVR with a bioprosthesis. The patients were allocated to three groups, based on their age at the time of surgery: > or = 80 years (n = 30), < 80 to > or = 70 years (n = 94), and < or = 70 years (n = 21). All data relating to preoperative risk factors were collected. A control examination, which included echocardiography, was performed at least five years after surgery, and the follow up was continued until July 2006. The number of deaths and causes of death, as well as valve-related complications, were noted.
The 30-day mortality rates were 3.3% in the oldest (> or = 80-year) group, 6.4% in the middle (< 80 to > or = 70-year) group, and zero in the youngest (< or = 70-year) group. The mean age at death was 88 and 81 years in the oldest and middle groups, respectively. In the oldest and youngest groups, there were no reoperations, but five valve-related reoperations were performed during follow up in the middle group. At the control visit, the left ventricular ejection fraction was > 60% in all groups. In the oldest and middle groups the aortic valve gradient was lower than the preoperative level, while the left ventricular diameters and wall dimensions were smaller (p < 0.05). Valve calcification was observed in one patient in the youngest group.
Elderly patients who had undergone AVR with a bioprosthesis had a good outcome after more than 10 years of follow up, with an improved cardiac function being preserved for at least seven years after surgery. Despite a severely impaired preoperative aortic valve function, octogenarians especially had a good life expectancy, possibly due to their low comorbidity rates. Hence, AVR with a bioprosthesis proved to be an excellent treatment in this patient group.
如今，全球老年人口持续增加，主动脉瓣狭窄（AS）的发病率随年龄增长而攀升。鉴于主动脉瓣置换术（AVR）是目前治疗有症状老年AS患者的方法，预计接受AVR手术的患者数量将会增加。
在1992年至1997年于赫尔辛基大学医院接受手术的患者中，选取一组（n = 145）接受生物瓣AVR手术的患者进行随访。根据手术时的年龄将患者分为三组：≥80岁（n = 30）、＜80至≥70岁（n = 94）、≤70岁（n = 21）。收集所有与术前危险因素相关的数据。术后至少五年进行一次包括超声心动图在内的对照检查，并持续随访至2006年7月。记录死亡人数、死亡原因以及瓣膜相关并发症。
最年长组（≥80岁）的30天死亡率为3.3%，中间组（＜80至≥70岁）为6.4%，最年轻组（≤70岁）为零。最年长组和中间组的平均死亡年龄分别为88岁和81岁。最年长组和最年轻组均未进行再次手术，但中间组在随访期间进行了5次瓣膜相关再次手术。在对照检查时，所有组的左心室射血分数均＞60%。最年长组和中间组的主动脉瓣压差低于术前水平，而左心室直径和室壁尺寸变小（p＜0.05）。最年轻组有1例患者观察到瓣膜钙化。
接受生物瓣AVR手术的老年患者在随访10多年后预后良好，术后至少七年心脏功能得以改善。尽管术前主动脉瓣功能严重受损，但八旬老人尤其具有良好的预期寿命，这可能归因于他们较低的合并症发生率。因此，生物瓣AVR被证明是该患者群体的一种极佳治疗方法。
