Saito Aya, Motomura Noboru, Miyata Hiroaki, Takamoto Shinichi, Kyo Shunei, Ono Minoru
Department of Cardiothoracic Surgery, The University of Tokyo, Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan.
Interact Cardiovasc Thorac Surg. 2011 Apr;12(4):575-80. doi: 10.1510/icvts.2010.254813. Epub 2011 Jan 12.
'Age' is a major risk factor in cardiac surgery, however, the precise risks accompanying 'age' have not been fully analyzed. This study aimed to clarify the age-specific risks affecting the short-term outcome after isolated coronary artery bypass grafting (CABG). Data of 13488 procedures were obtained from the Japan Adult Cardiovascular Surgery Database, and the patients were divided into three groups; under 65 years of age ('Young', n=4420), 65-75 ('Middle', n=5485), and over 75 years of age ('Old', n=3583). As a preoperative profile, 'Old' tended to have extracardiac arteriopathy, left main stenosis, and emergency operation, whereas, 'Young' had more coronary risk factors (smoking, diabetes, dyslipidemia) and low left ventricular (LV) function. The 30-day operative mortality rate increased significantly with age ('Young': 1.7%, 'Middle': 2.3%, 'Old': 4.3%, P<0.0001). Renal dysfunction, arrhythmia, preoperative inotropes, and emergency surgery were the predictors for mortality common to all groups. Besides these, 'Young' only had cardiac factors as additional risks, whereas various factors including cardiac parameters, redo sternotomy, peripheral vascular disease, and chronic lung disease were the additional risks in the elderly. Thus, the elderly population was vulnerable to any kind of factors, and preoperative systemic evaluation was crucial in the elderly to help define the appropriate surgical candidates.
“年龄”是心脏手术的一个主要风险因素，然而，与“年龄”相关的具体风险尚未得到充分分析。本研究旨在阐明影响单纯冠状动脉旁路移植术（CABG）术后短期结局的特定年龄风险。从日本成人心血管外科数据库中获取了13488例手术的数据，患者被分为三组：65岁以下（“年轻组”，n = 4420）、65 - 75岁（“中年组”，n = 5485）和75岁以上（“老年组”，n = 3583）。作为术前概况，“老年组”往往患有心外动脉病变、左主干狭窄并接受急诊手术，而“年轻组”有更多的冠状动脉危险因素（吸烟、糖尿病、血脂异常）和较低的左心室（LV）功能。30天手术死亡率随年龄显著增加（“年轻组”：1.7%，“中年组”：2.3%，“老年组”：4.3%，P < 0.0001）。肾功能不全、心律失常、术前使用血管活性药物和急诊手术是所有组共有的死亡预测因素。除此之外，“年轻组”仅将心脏因素作为额外风险，而包括心脏参数、再次开胸手术、外周血管疾病和慢性肺病在内的各种因素是老年人的额外风险。因此，老年人群对任何类型的因素都很脆弱，术前全面评估对老年人至关重要，可以帮助确定合适的手术候选者。
