From the Department of Cardiothoracic and Vascular Anaesthesia and Intensive Care Medicine, University Hospital of Vienna (AL,MH,MM), Institute of Medical Statistics, Medical University of Vienna (SF,WB), Clinical Institute of Infection Control and Hospital Epidemiology, University Hospital of Vienna, Vienna, Austria (EP), Anesthésie Réanimation Chirurgie Cardio-thoracique et Vasculaire, CHU Pierre Zobda-Quitman Fort de France, Martinique, France (CI), Horten Centre, University Hospital Zürich, Zürich, Switzerland (LMB), Department of Cardiac Surgery, University Hospital of Vienna, Vienna (MA), Department of Cardiac Surgery, University Hospital of Salzburg, Salzburg, Austria (RS), Anaesthesia and Intensive Care Medicine, Hirslanden Klinik Im Park, Zürich, Switzerland (DS).
Eur J Anaesthesiol. 2013 Nov;30(11):695-703. doi: 10.1097/EJA.0b013e3283657829.
Aortic valve replacement is one of the most common cardiac surgical procedures, especially in elderly patients. Whether or not there is a net life gain over a long period of time is a matter for debate.
To compare survival of patients with that of the age, sex, and follow-up year-matched normal population (relative survival).
Single-centre, prospectively collected data.
Tertiary care centre, Vienna, Austria.
We enrolled 1848 patients undergoing elective aortic valve replacement between 1997 and the end of 2008.
None.
Relative survival at the end of 2011 as determined by relative Cox regression analysis.
Sixty-nine patients (3.7%) died within the first 30 days. Another 70 patients (3.8%) died within the first year and 429 (23.2%) died during the remaining follow-up period. The longest follow-up period was 14 years (median, 5.8; interquartile range, 3.2 to 8.9). Medical risk indicators for relative survival were diabetes mellitus [hazard ratio 1.69, 95% confidence interval, CI 1.37 to 2.07, P<0.001], pulmonary disease (hazard ratio 1.45, 95% CI 1.16 to 1.81, P=0.001), history of atrial fibrillation (hazard ratio 1.35, 95% CI 1.10 to 1.66, P=.005) and angiotensin-converting enzyme inhibitor medication (hazard ratio 1.21, 95% CI 1.02 to 1.44, P=0.031). Perioperative risk indicators were urgent surgery (hazard ratio 1.40, 95% CI 1.00 to 1.94, P=0.047), resternotomy at 48 h or less (hazard ratio 1.87, 95% CI 1.29 to 2.70, P=0.001), resternotomy at more than 48 h (hazard ratio 1.80, 95% CI 1.32 to 2.45, P<0.001), blood transfusion (hazard ratio 1.06, 95% CI 1.01 to 1.12, P=0.018) and renal replacement therapy (hazard ratio 2.02, 95% CI 1.41 to 2.90, P<0.001). Relative survival was highest in the oldest age quartile (76 to 94 years) and lowest in the youngest (19 to 58 years) (hazard ratio 0.27, 95% CI 0.21 to 0.36; P<0.001).
Patients who survived the first year after aortic valve replacement had a similar chance of survival as the matched normal population. Relative survival benefit was higher in the oldest age quartile.
主动脉瓣置换术是最常见的心脏外科手术之一，尤其是在老年患者中。在很长一段时间内是否存在净生存获益是一个有争议的问题。
比较患者的生存情况与年龄、性别和随访年限匹配的正常人群（相对生存）。
单中心、前瞻性收集数据。
奥地利维也纳的三级护理中心。
我们纳入了 1997 年至 2008 年底期间接受择期主动脉瓣置换术的 1848 例患者。
无。
采用相对 Cox 回归分析确定 2011 年底的相对生存率。
30 天内有 69 例（3.7%）患者死亡。另外 70 例（3.8%）患者在术后 1 年内死亡，429 例（23.2%）患者在剩余随访期间死亡。最长随访时间为 14 年（中位数为 5.8 年；四分位间距为 3.2 年至 8.9 年）。影响相对生存的医学风险指标包括糖尿病（风险比 1.69，95%置信区间 1.37 至 2.07，P<0.001）、肺部疾病（风险比 1.45，95%置信区间 1.16 至 1.81，P=0.001）、心房颤动史（风险比 1.35，95%置信区间 1.10 至 1.66，P=0.005）和血管紧张素转换酶抑制剂治疗（风险比 1.21，95%置信区间 1.02 至 1.44，P=0.031）。围手术期风险指标包括紧急手术（风险比 1.40，95%置信区间 1.00 至 1.94，P=0.047）、48 小时内再次开胸（风险比 1.87，95%置信区间 1.29 至 2.70，P=0.001）、48 小时后再次开胸（风险比 1.80，95%置信区间 1.32 至 2.45，P<0.001）、输血（风险比 1.06，95%置信区间 1.01 至 1.12，P=0.018）和肾脏替代治疗（风险比 2.02，95%置信区间 1.41 至 2.90，P<0.001）。在年龄最大的四分位数（76 岁至 94 岁）中，相对生存率最高，而在年龄最小的四分位数（19 岁至 58 岁）中最低（风险比 0.27，95%置信区间 0.21 至 0.36；P<0.001）。
主动脉瓣置换术后存活 1 年以上的患者与匹配的正常人群有相似的生存机会。年龄最大的四分位数的相对生存获益更高。
