Raja Shahzad G, Navaratnarajah Manoraj, Husain Mubassher, Walker Christopher P, Ilsley Charles D, Bahrami Toufan T, Gaer Julien A, Amrani Mohamed
Department of Cardiac Surgery, Harefield Hospital, London, United Kingdom.
J Heart Valve Dis. 2013 Mar;22(2):177-83.
Abundant data are available reporting excellent in-hospital outcomes after surgical aortic valve replacement (AVR) in octogenarians. However, there is a paucity of studies reporting the in-hospital outcome of concomitant AVR and coronary artery bypass grafting (CABG) in this group of patients. Hence, a comparison was made of the impact of concomitant AVR and CABG versus isolated AVR on in-hospital outcome in octogenarians.
Between January 2001 and October 2011, a total of 114 consecutive octogenarians undergoing combined AVR and CABG were compared with a control group of octogenarians (n = 68) undergoing isolated AVR. A retrospective analysis was performed of a prospectively collected cardiac surgery database. In addition, the medical notes and charts of all study patients were reviewed.
The two groups had a similar mean age (AVR 82.3 +/- 2.4 years versus AVR + CABG 82.6 +/- 2.1 years; p = 0.91), demographics and EuroSCORE (AVR 11.4 versus AVR + CABG 13.2; p = 0.12). The aortic cross-clamp and cardiopulmonary bypass times were longer for AVR + CABG patients (p < 0.001). In-hospital mortality (7.4% after isolated AVR, 9.6% after AVR + CABG; p = 0.35 between groups) and major clinical outcomes for the two groups were found to be similar except for an increased need for hemofiltration in AVR + CABG patients (p = 0.02).
In-hospital outcomes for concomitant AVR and CABG in octogenarians are comparable to those of isolated AVR, justifying the performance of combined AVR and CABG in this high-risk group of carefully selected patients.
有大量数据报道了八旬老人行外科主动脉瓣置换术（AVR）后良好的院内结局。然而，关于该组患者同期行AVR与冠状动脉旁路移植术（CABG）的院内结局的研究却很少。因此，对八旬老人同期行AVR与CABG和单纯AVR对院内结局的影响进行了比较。
2001年1月至2011年10月，将114例连续接受AVR与CABG联合手术的八旬老人与一组接受单纯AVR的八旬老人对照组（n = 68）进行比较。对前瞻性收集的心脏手术数据库进行回顾性分析。此外，还查阅了所有研究患者的病历和图表。
两组的平均年龄相似（AVR组为82.3±2.4岁，AVR + CABG组为82.6±2.1岁；p = 0.91），人口统计学特征和欧洲心脏手术风险评估系统（EuroSCORE）评分也相似（AVR组为11.4，AVR + CABG组为13.2；p = 0.12）。AVR + CABG患者的主动脉阻断时间和体外循环时间更长（p < 0.001）。除AVR + CABG患者对血液滤过的需求增加外（p = 0.02），两组的院内死亡率（单纯AVR后为7.4%，AVR + CABG后为9.6%；组间p = 0.35）和主要临床结局相似。
八旬老人同期行AVR与CABG的院内结局与单纯AVR相当，这证明在这一经过精心挑选的高危患者群体中进行AVR与CABG联合手术是合理的。
