主动脉瓣置换术：2256 例患者当代系列的死亡率结果和预测因素。
Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients.
机构信息
Department of Cardiac Surgery, S'Orsola Hospital, University of Bologna, Bologna, Italy.
出版信息
J Thorac Cardiovasc Surg. 2011 Apr;141(4):940-7. doi: 10.1016/j.jtcvs.2010.05.044. Epub 2010 Jul 6.
OBJECTIVE
The study's objectives were to evaluate results and identify predictors of hospital and mid-term mortality after primary isolated aortic valve replacement; compare early and mid-term survival of patients aged more than 80 years or less than 80 years; and assess the effectiveness of the logistic European System for Cardiac Operative Risk Evaluation in predicting the risk for hospital mortality in octogenarians with a logistic European System for Cardiac Operative Risk Evaluation greater than 15% who are undergoing aortic valve replacement.
METHODS
Data from 2256 patients undergoing primary isolated aortic valve replacement between January 2003 and December 2007 were prospectively collected in a Regional Registry (Regione Emilia Romagna Interventi Cardiochirurgia) and analyzed to estimate hospital and mid-term results.
RESULTS
Overall hospital mortality was 2.2%. By multivariate analysis, New York Heart Association III and IV, Canadian Cardiovascular Society III and IV, pulmonary artery pressure greater than 60 mm Hg, dialysis, central neurologic dysfunction, and severe chronic obstructive pulmonary disease emerged as independent predictors of hospital mortality. At 3 years, the survival was 89.3%. The same predictors of hospital mortality plus ejection fraction of 30% to 50% and age more than 80 years emerged as independent risk factors for 3-year mortality. Compared with younger patients, octogenarians had a higher hospital mortality rate (3.72% vs 1.81%; P = .0143) and a reduced 3-year survival (82.3% vs 91.3%; P < .001). Three-year survival of octogenarians was comparable to the expected survival of an age- and gender-matched regional population (P = .157). The observed mortality rate in octogenarians with a logistic European System for Cardiac Operative Risk Evaluation greater than 15% (mean: 22.4%) was 7% (P < .001).
CONCLUSIONS
This study provides contemporary data on the characteristics and outcome of patients undergoing first-time isolated aortic valve replacement.
目的
本研究旨在评估初次单纯主动脉瓣置换术后患者的住院和中期死亡率结果，并识别其预测因素；比较 80 岁以上和 80 岁以下患者的早期和中期存活率；评估欧洲心脏手术风险评估系统（logistic European System for Cardiac Operative Risk Evaluation，EuroSCORE）在预测行主动脉瓣置换术的 80 岁以上且 EuroSCORE 大于 15%的患者住院死亡率方面的有效性。
方法
2003 年 1 月至 2007 年 12 月期间，前瞻性地在一个地区注册处（意大利艾米利亚-罗马涅大区心脏手术注册处）收集了 2256 例接受初次单纯主动脉瓣置换术的患者的数据，并进行分析以评估住院和中期结果。
结果
总的住院死亡率为 2.2%。多因素分析显示，纽约心脏协会心功能分级（New York Heart Association，NYHA）Ⅲ级和Ⅳ级、加拿大心血管学会心功能分级（Canadian Cardiovascular Society，CCS）Ⅲ级和Ⅳ级、肺动脉压大于 60mmHg、透析、中枢神经系统功能障碍和严重慢性阻塞性肺疾病是住院死亡率的独立预测因素。3 年时，存活率为 89.3%。住院死亡率的相同预测因素加上射血分数为 30%至 50%和年龄大于 80 岁是 3 年死亡率的独立危险因素。与年轻患者相比，80 岁以上患者的住院死亡率更高（3.72%比 1.81%；P=.0143），3 年存活率更低（82.3%比 91.3%；P<.001）。80 岁以上患者的 3 年存活率与年龄和性别匹配的地区人群的预期存活率相当（P=.157）。EuroSCORE 大于 15%的 80 岁以上患者的观察死亡率（平均：22.4%）为 7%（P<.001）。
结论
本研究提供了初次行单纯主动脉瓣置换术患者的特征和结果的最新数据。
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