Carnero-Alcázar Manuel, Reguillo-Lacruz Fernando, Alswies Ali, Villagrán-Medinilla Enrique, Maroto-Castellanos Luis Carlos, Rodríguez-Hernández Joséenrique
Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain.
Interact Cardiovasc Thorac Surg. 2010 Apr;10(4):549-54. doi: 10.1510/icvts.2009.218040. Epub 2010 Jan 25.
Population over 80 years who require surgery for degenerative aortic stenosis has largely increased in the past decades. We have compared short- and mid-term results for conventional aortic valve replacement (AVR) for calcific-degenerative aortic stenosis in older and younger than 80 years operated at our institution between April 2004 and December 2008. Predictors of mortality and major adverse cardio and cerebrovascular events (MACCEs) on the postoperative and follow-up period were determined through multivariable analysis. Four hundred and fifty-one patients were included in the study. Ninety-four (20.8%) were >or=80. Previous cardiac surgery [odds ratio (OR)=4.08, P=0.047], renal failure (OR=6.75, P<0.001), concomitant coronary artery bypass grafting (CABG) (OR=2.57, P=0.034), female sex (OR=2.49, P=0.047), and severe pulmonary hypertension (OR=3.68, P=0.024) were independent predictors of in-hospital mortality. In the follow-up, age >or=80 years [Hazard ratio (HR)=2.44, P=0.02], high blood pressure (HBP) (HR=5.2, P=0.025) and peripheral arterial disease (PAD) (HR=5.1, P<0.001) were independent predictors for late mortality. Only PAD (HR=3.55, P=0.014) and HBP (HR=8.24, P=0.04) were independent predictors for late cardiac mortality. Renal failure (OR=2.57, P=0.005), severe pulmonary hypertension (OR=3.49, P=0.005) and concomitant CABG (OR=2.49, P=0.002) were independent predictors for postoperative MACCEs. Diabetes mellitus (HR=2.03, P=0.033) and PAD (HR=2.3, P=0.041) were independent predictors for MACCEs in the follow-up. According to these data, we can conclude that conventional open AVR for degenerative aortic stenosis grants good early- and mid-term outcomes in octogenarians in our experience.
在过去几十年中，因退行性主动脉瓣狭窄而需要进行手术的80岁以上人群大幅增加。我们比较了2004年4月至2008年12月在我们机构接受手术的80岁及以上和80岁以下钙化性退行性主动脉瓣狭窄患者进行传统主动脉瓣置换术（AVR）的短期和中期结果。通过多变量分析确定术后和随访期间死亡率及主要不良心脑血管事件（MACCEs）的预测因素。该研究纳入了451例患者。其中94例（20.8%）年龄≥80岁。既往心脏手术[比值比（OR）=4.08，P=0.047]、肾衰竭（OR=6.75，P<0.001）、同期冠状动脉旁路移植术（CABG）（OR=2.57，P=0.034）、女性（OR=2.49，P=0.047）和重度肺动脉高压（OR=3.68，P=0.024）是院内死亡的独立预测因素。在随访中，年龄≥80岁[风险比（HR）=2.44，P=0.02]、高血压（HBP）（HR=5.2，P=0.025）和外周动脉疾病（PAD）（HR=5.1，P<0.001）是晚期死亡的独立预测因素。只有PAD（HR=3.55，P=0.014）和HBP（HR=8.24，P=0.04）是晚期心脏死亡的独立预测因素。肾衰竭（OR=2.57，P=0.005）、重度肺动脉高压（OR=3.49，P=0.005）和同期CABG（OR=2.49，P=0.002）是术后MACCEs的独立预测因素。糖尿病（HR=2.03，P=0.033）和PAD（HR=2.3，P=0.041）是随访期间MACCEs的独立预测因素。根据这些数据，我们可以得出结论，在我们的经验中，对于退行性主动脉瓣狭窄进行传统开放性AVR可使八旬老人获得良好的早期和中期结果。
