老年人房间隔缺损的外科矫治

Surgical correction of atrial septal defect in the elderly.

作者信息

Rudiene Virginija, Gumbiene Lina, Dranenkiene Alicija, Karalius Rimantas, Sirmenis Raimondas, Tarutis Virgilijus

机构信息

Centre of Cardiology and Angiology, Vilnius University Hospital, Santariskiu Klinikos, Lithuania.

Centre of Cardiology and Angiology, Vilnius University Hospital, Santariskiu Klinikos, Lithuania ; Clinic of Cardiovascular Diseases, Faculty of Medicine, Vilnius University, Lithuania ; Centre of Cardiac Surgery, Vilnius University Hospital, Santariskiu Klinikos, Lithuania.

出版信息

Kardiochir Torakochirurgia Pol. 2014 Dec;11(4):391-6. doi: 10.5114/kitp.2014.47338. Epub 2014 Nov 30.

DOI:10.5114/kitp.2014.47338

PMID:26336455

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4349036/

Abstract

INTRODUCTION

Atrial septal defects (ASDs) are one of the most common congenital malformations in adults. Correction of ASDs in advanced age remains controversial, even though beneficial effects in this patient group were found in recent studies. In older patients, less invasive transcatheter closure of ASDs has been recommended.

AIM

The aim of this study was to analyze our advanced age ASD surgical cohort: early and late results.

MATERIAL AND METHODS

Retrospective analysis of 32 patients operated on at an age of ≥ 60 years (i.e. age 66.13 ± 4.8, range from 60 to 78) in our center between 2001 and 2011 was carried out. We reviewed our experience of surgical ASD closure in elderly patients over a 10-year period to assess the effects of this type of treatment on early postoperative and long-term survival, early and late complications, preoperative and postoperative clinical status (New York Heart Association [NYHA] functional class), pulmonary hypertension (PH) and atrial arrhythmias. The patients were divided into two groups according to age.

RESULTS

The frequency of comorbidities was lower in younger age group patients (11 [61%] vs. 13 [93%], p < 0.05). Atrial fibrillation/flutter was found in 21 (66%) of all patients. Late postoperative mortality was higher in the older patient group (3 [21%] vs. 1 [5.6%]). Despite this, we observed significant improvement of symptoms and functional ability in the older population after surgical ASD closure (group I, n = 10 [56%] vs. group II, n = 12 [86%]).

CONCLUSIONS

Surgical correction of clinically significant ASD is effective even in older patients with comorbidities.

摘要

引言

房间隔缺损（ASD）是成人中最常见的先天性畸形之一。尽管近期研究发现对这一患者群体有有益效果，但高龄患者房间隔缺损的矫正仍存在争议。对于老年患者，推荐采用侵入性较小的经导管封堵术。

目的

本研究的目的是分析我们中心高龄房间隔缺损手术队列的早期和晚期结果。

材料与方法

对2001年至2011年期间在我们中心接受手术的32例年龄≥60岁（即年龄66.13±4.8岁，范围60至78岁）的患者进行回顾性分析。我们回顾了10年间老年患者房间隔缺损手术闭合的经验，以评估这种治疗方式对术后早期和长期生存、早期和晚期并发症、术前和术后临床状况（纽约心脏协会[NYHA]功能分级）、肺动脉高压（PH）和房性心律失常的影响。根据年龄将患者分为两组。

结果

较年轻年龄组患者的合并症发生率较低（11例[61%]对13例[93%]，p<0.05）。所有患者中有21例（66%）出现房颤/房扑。老年患者组术后晚期死亡率较高（3例[21%]对1例[5.6%]）。尽管如此，我们观察到老年人群在房间隔缺损手术闭合后症状和功能能力有显著改善（I组，n = 10例[56%]对II组，n = 12例[86%]）。