Takase Shinya, Yokoyama Hitoshi, Satokawa Hirono, Sato Yoshiyuki, Kurosawa Hiroyuki, Seto Yuki, Kagoshima Akihito, Igarashi Takashi
Department of Cardiovascular Surgery, Fukushima Medical University School of Medicine, 1-Hikarigaoka, Fukushima, 960-1295, Japan.
Gen Thorac Cardiovasc Surg. 2010 Nov;58(11):561-7. doi: 10.1007/s11748-010-0640-9. Epub 2010 Nov 11.
Off-pump coronary artery bypass has been reported to be associated with reduced morbidity and mortality after surgical coronary revascularization, especially in high-risk patients. The aim of this study was to clarify the efficacy of off-pump coronary artery bypass for the very elderly patients.
We compared the outcomes of octogenarians (n = 28, 82 ± 2 years) undergoing off-pump coronary artery bypass and those of the patients <80 years of age (n = 315, 67 ± 9 years) during short- and long-term periods.
There was no difference in hospital mortality between octogenarians and the younger cohort (3.8% vs. 0.6%; P = 0.11). A high rate of postoperative complications (e.g., pneumonia, transient renal dysfunction, ventricular arrhythmia) were observed in the octogenarians. The long-term survival (81% at 5 years) and the rate of freedom from cardiac death (92% at 5 years) and from cardiac events (85% at 5 years) were excellent in the octogenarians; they appeared less favorable, however, when compared with the younger group (95%, 98%, and 94% at 5 years, respectively). Most of the cardiac adverse events, including unexplained sudden death, occurred 6 months after the surgery in octogenarians.
Off-pump coronary artery bypass can be performed safely in octogenarians, with excellent early and late outcomes. Careful postoperative follow-up is required to reduce postoperative long-term adverse events. Off-pump coronary artery bypass is a feasible modality of coronary revascularization for octogenarians.
据报道，非体外循环冠状动脉搭桥术与冠状动脉血运重建术后发病率和死亡率的降低相关，尤其是在高危患者中。本研究的目的是阐明非体外循环冠状动脉搭桥术对高龄患者的疗效。
我们比较了接受非体外循环冠状动脉搭桥术的八旬老人（n = 28，82±2岁）与80岁以下患者（n = 315，67±9岁）在短期和长期的预后情况。
八旬老人与年轻队列的住院死亡率无差异（3.8%对0.6%；P = 0.11）。八旬老人术后并发症发生率较高（如肺炎、短暂性肾功能不全、室性心律失常）。八旬老人的长期生存率（5年时为81%）、无心脏死亡生存率（5年时为92%）和无心脏事件生存率（5年时为85%）良好；然而，与年轻组相比（5年时分别为95%、98%和94%），这些生存率似乎较低。包括不明原因猝死在内的大多数心脏不良事件发生在八旬老人术后6个月。
非体外循环冠状动脉搭桥术可在八旬老人中安全进行，早期和晚期预后良好。需要进行仔细的术后随访以减少术后长期不良事件。非体外循环冠状动脉搭桥术是八旬老人可行的冠状动脉血运重建方式。
