Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Am J Cardiol. 2010 Jun 15;105(12):1815-20. doi: 10.1016/j.amjcard.2010.01.366. Epub 2010 Apr 27.
Percutaneous balloon aortic valvuloplasty (PBAV) is a procedure used for palliation, bridging to surgery, and as an integral step in the procedure for percutaneous aortic valve replacement. Older patients with severe aortic stenosis are thought to have greater risk for adverse perioperative events than younger patients. The aim of this study was to evaluate the outcomes of patients aged >80 years and those aged < or =80 years who underwent PBAV to identify factors associated with adverse clinical outcomes. This was a retrospective study of 111 consecutive patients with severe symptomatic aortic stenosis who underwent retrograde PBAV at Massachusetts General Hospital from December 2004 to December 2008. Forty-nine patients (44%) were men, and the mean age for the whole group was 82 +/- 8 years. Patients were divided into 2 age groups: those aged >80 years (n = 73) and those aged < or =80 years (n = 38). Procedural outcomes, complications, and in-hospital adverse events were compared. Multivariate logistic regression was used for the adjusted analysis. Nearly 90% of patients were in New York Heart Association class III or IV. Patients aged >80 years had lower baseline ejection fractions (43.5% vs 56.1%, p <0.01) and smaller aortic valve areas (0.59 vs 0.73 cm(2), p <0.01). Although the 2 age groups had a similar percentage of aortic valve area increase (55.5% vs 45.2%, p = 0.28), those aged >80 years had smaller post-PBAV aortic valve areas (0.89 vs 1.02 cm(2), p <0.05). Overall, in-hospital mortality was 8.1%, with no significant differences between the groups. Advanced age was not an independent predictor of in-hospital death, myocardial infarction, stroke, cardiac arrest, or tamponade; however, patients aged >80 years had a significantly higher incidence of intraprocedural emergent intubation and cardiopulmonary resuscitation compared to the younger group. New York Heart Association class was the only independent predictor of worse in-hospital outcomes. In conclusion, compared to younger patients, those aged >80 years had less favorable preprocedural characteristics for PBAV but similar overall in-hospital clinical outcomes. Patients aged >80 years had significantly higher incidence of emergent intubation and cardiopulmonary resuscitation during PBAV.
经皮球囊主动脉瓣成形术（PBAV）是一种用于姑息治疗、手术搭桥以及经皮球囊主动脉瓣置换术的一个重要步骤。与年轻患者相比，患有严重主动脉瓣狭窄的老年患者被认为具有更大的围手术期不良事件风险。本研究的目的是评估接受 PBAV 治疗的年龄>80 岁患者和年龄≤80 岁患者的结局，以确定与不良临床结局相关的因素。这是一项回顾性研究，纳入了 2004 年 12 月至 2008 年 12 月在马萨诸塞州总医院接受逆行 PBAV 的 111 例严重有症状的主动脉瓣狭窄患者。49 例（44%）为男性，全组平均年龄为 82±8 岁。患者分为 2 个年龄组：年龄>80 岁（n=73）和年龄≤80 岁（n=38）。比较了手术结果、并发症和住院期间的不良事件。采用多变量逻辑回归进行校正分析。近 90%的患者处于纽约心脏协会（NYHA）心功能 III 或 IV 级。年龄>80 岁的患者的基线射血分数较低（43.5% vs 56.1%，p<0.01），主动脉瓣面积较小（0.59 vs 0.73cm2，p<0.01）。尽管 2 个年龄组的主动脉瓣面积增加百分比相似（55.5% vs 45.2%，p=0.28），但年龄>80 岁的患者的 PBAV 后主动脉瓣面积较小（0.89 vs 1.02cm2，p<0.05）。总的来说，住院期间死亡率为 8.1%，2 个组之间无显著差异。高龄并不是住院期间死亡、心肌梗死、卒中和心脏骤停或心脏压塞的独立预测因素；然而，与年轻组相比，年龄>80 岁的患者在 PBAV 期间紧急插管和心肺复苏的发生率显著更高。NYHA 心功能分级是住院期间结局恶化的唯一独立预测因素。结论：与年轻患者相比，年龄>80 岁的患者接受 PBAV 的术前特征较差，但总体住院临床结局相似。年龄>80 岁的患者在 PBAV 期间紧急插管和心肺复苏的发生率显著更高。
