Yoneyama Fumiya, Tokunaga Chiho, Enomoto Yoshiharu, Mitomi Kisato, Sakamoto Hiroaki, Hiramatsu Yuji
Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Ann Thorac Cardiovasc Surg. 2017 Jun 20;23(3):123-127. doi: 10.5761/atcs.oa.16-00303. Epub 2017 Mar 9.
This study examined mid-term outcomes of valve surgery in the elderly, and focused on the difference in outcomes between isolated and combined valve surgery.
From January 2012 to June 2016, 113 consecutive patients aged 75 years and older underwent valve surgery. In all, 60 underwent isolated valve surgery (Group I), and 53 underwent combined valve surgery (Group C) involving the combination of any valve procedures or valve surgery with concurrent other procedure. Short- and mid-term outcomes were compared between the two groups.
There was no significant difference in length of intensive care unit stay (2.8 days in Group S vs. 4.2 days in Group C, p = 0.08), hospital stay (16.2 vs. 18.7 days, p = 0.22), and mechanical ventilation (11.2 vs. 15.0 hours, p = 0.28). Neither was there any significant difference in operative mortality (1.6% vs. 5.6%, p = 0.25) nor morbidity (8.3% vs. 9.4%, p = 0.83) between the two groups. Actuarial survival rates at 1 and 3 years were 98.3% in Group S and 92.0% in Group C (log-rank p = 0.126).
Once patients have tolerated combined surgery during the early postoperative period, good survival rates equaling those of isolated valve surgery can be expected.
本研究调查了老年患者瓣膜手术的中期结果,并重点关注单纯瓣膜手术与联合瓣膜手术在结果上的差异。
2012年1月至2016年6月,113例年龄在75岁及以上的连续患者接受了瓣膜手术。其中,60例接受单纯瓣膜手术(I组),53例接受联合瓣膜手术(C组),联合瓣膜手术包括任何瓣膜手术或瓣膜手术与同期其他手术的联合。比较两组的短期和中期结果。
重症监护病房住院时间(S组为2.8天,C组为4.2天,p = 0.08)、住院时间(16.2天对18.7天,p = 0.22)和机械通气时间(11.2小时对15.0小时,p = 0.28)在两组之间无显著差异。两组的手术死亡率(1.6%对5.6%,p = 0.25)和发病率(8.3%对9.4%,p = 0.83)也无显著差异。S组1年和3年的精算生存率分别为98.3%和92.0%(对数秩检验p = 0.126)。
一旦患者在术后早期耐受联合手术,可预期获得与单纯瓣膜手术相当的良好生存率。