Vicchio Mariano, Feo Marisa De, Giordano Salvatore, Provenzano Raffaella, Cotrufo Maurizio, Nappi Gianantonio
Department of Cardiovascular Surgery Pineta Grande Hospital Castel Volturno Caserta 81030, Italy.
J Cardiothorac Surg. 2012 Feb 6;7:13. doi: 10.1186/1749-8090-7-13.
Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians.Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed.Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains).Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG.
心肌缺血在老年人中常与主动脉瓣狭窄相关。本研究的目的是评估在七十多岁和八十多岁的老年人中，冠状动脉旁路移植术（CABG）联合主动脉瓣置换术对生存和生活质量的影响。1991年1月至2010年1月期间，520名年龄大于70岁的患者在两家机构接受了机械瓣膜主动脉瓣置换术。他们被分为两组：A组包括406例接受单纯主动脉瓣置换术的患者；B组114例接受主动脉瓣置换术和CABG的患者。对长期生存和生活质量（SF-36测试）进行了比较分析。平均年龄为74.2±3.6岁（A组74.3±3.6岁，B组74±3.3岁；p = 0.33）。医院死亡率为9.5%（46例患者）。A组29例（7.8%），B组17例（15.2%）（p = 0.019）。1年时的精算生存率为88.5%±0.015，5年时为81.9%±0.02，10年时为76.6%±0.032，15年时为57.3±0.1。10年生存率A组为77%±0.034，B组为77.8%±0.045（p = 0.2）。多变量分析未显示联合CABG是长期死亡率的预测因素。两组在SF-36测试中获得的分数相似，且显著高于按国家、年龄和性别匹配的一般人群（所有领域p < 0.001）。联合CABG会使接受主动脉瓣置换术的老年人医院死亡率显著增加。根据是否存在联合CABG，幸存者在长期结局和生活质量方面未显示出差异。
