Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Department of Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
J Thorac Cardiovasc Surg. 2017 Nov;154(5):1544-1553.e1. doi: 10.1016/j.jtcvs.2017.05.047. Epub 2017 May 23.
To analyze outcomes and predictors of functional survival (personal care home admission and mortality) and hospital readmission in patients aged ≥80 years who underwent surgical aortic valve replacement (SAVR) in a Manitoba hospital.
This was a retrospective cohort study of patients aged ≥80 years who underwent SAVR with or without coronary artery bypass grafting in Manitoba between 1995 and 2014. Data from the Manitoba Adult Cardiac Surgery database and the Manitoba Centre for Health Policy were used. Kaplan-Meier estimates of outcomes and Cox multivariate regression analysis of risk factors were performed. Survival was compared with that of age- and sex-matched life expectancy.
A total of 1872 patients were aged ≥50 years and 378 were aged ≥80 years, 55% of whom (n = 208) underwent concurrent coronary artery bypass grafting. Compared with younger patients, octogenarians had higher in-hospital mortality (8.5%; P <.001), longer median intensive care unit stay (47.2 hours; P <.001), and longer median in-hospital stay (13 days; P <.001). The median follow-up was 5.2 years. Functional survival was 82.4% at 1 year and 56.5% at 5 years, and freedom from hospital readmission was 61.5% at 1 year and 28.4% at 5 years. Survival approximated the age- and sex-matched life expectancy at 1 year (83.8%) and 5 years (60.8%). Preoperative atrial fibrillation, peripheral vascular disease, female sex, postoperative acute kidney injury, and blood transfusion were associated with adverse outcomes.
In eligible octogenarians, SAVR has acceptable 1- and 5-year functional survival and hospital readmission rates, but significant perioperative mortality and morbidity.
分析在马尼托巴省医院接受手术主动脉瓣置换术（SAVR）的 80 岁以上患者的功能生存（入住养老院和死亡）和再入院的结局和预测因素。
这是一项回顾性队列研究，纳入了 1995 年至 2014 年间在马尼托巴省接受 SAVR 治疗的 80 岁以上患者，包括单纯 SAVR 或 SAVR 联合冠状动脉旁路移植术。研究使用了马尼托巴省成人心脏外科数据库和马尼托巴省卫生政策中心的数据。采用 Kaplan-Meier 估计生存情况，并进行 Cox 多变量回归分析风险因素。生存情况与年龄和性别匹配的预期寿命进行比较。
共有 1872 名患者年龄≥50 岁，378 名患者年龄≥80 岁，其中 55%（n=208）接受了同期冠状动脉旁路移植术。与年轻患者相比，80 岁以上的患者院内死亡率更高（8.5%；P<.001），重症监护病房中位住院时间更长（47.2 小时；P<.001），院内中位住院时间更长（13 天；P<.001）。中位随访时间为 5.2 年。1 年时的功能生存率为 82.4%，5 年时为 56.5%，1 年时无再入院率为 61.5%，5 年时为 28.4%。生存情况在 1 年时接近年龄和性别匹配的预期寿命（83.8%），在 5 年时接近预期寿命（60.8%）。术前心房颤动、外周血管疾病、女性、术后急性肾损伤和输血与不良结局相关。
在符合条件的 80 岁以上患者中，SAVR 的 1 年和 5 年功能生存率和再入院率可接受，但围手术期死亡率和发病率较高。
