Vetta Francesco, Locorotondo Gabriella, Vetta Giampaolo, Mignano Maria, Bracchitta Sonia
Israelitico Hospital.
Monaldi Arch Chest Dis. 2017 Jul 18;87(2):855. doi: 10.4081/monaldi.2017.855.
Over the past few decades, the progressive aging of the population combined with the resulting increase in cardiovascular disease and the marked improvement of technologies applied to surgery justify the marked increase of the elderly patients requiring cardiovascular surgery. This claims a highly skilled perioperative management, which should be aimed at treating cardiac disease without increasing risk of hospitalization-related harmful events. Current preoperative assessment for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II (EUROSCORE II) and the Society of Thoracic Surgeons (STS) risk score, are limited in their ability to predict perioperative outcomes in older patients. This is because patients' chronological age should not be considered as the only tool to identify the surgical risk. In recent years, indeed, several studies have highlighted the role of frailty syndrome in determining the prognosis of elderly patients undergoing cardiac surgery. Particularly, some functional aspects, such as gait speed seem to have a high sensitivity and specificity in this regard. Therefore, further research is needed in order not only to identify a unique, fast and easy to use tool aimed to recognize frailty syndrome, but chiefly resulting able to give us information about the effectiveness of focused preoperative interventions. Finally, we need to have scientific data on the role that surgical, percutaneous and transcatheter procedures have on outcome in elderly patients in terms of perioperative mortality, postoperative quality of life and regarding the possible reversibility of frailty. Cardiovascular surgery is to date a "moving target", due to changing face of patients and changing face of technical requirements and perioperative management should reflect such changes.
在过去几十年中，人口的逐渐老龄化，加上由此导致的心血管疾病增加以及应用于手术的技术显著进步，使得需要进行心血管手术的老年患者显著增多。这就需要高超的围手术期管理，其目标应是在不增加与住院相关有害事件风险的情况下治疗心脏病。目前用于心脏手术的术前评估，如欧洲心脏手术风险评估系统II（EUROSCORE II）和胸外科医师协会（STS）风险评分，在预测老年患者围手术期结局方面能力有限。这是因为不应将患者的实际年龄视为识别手术风险的唯一工具。事实上，近年来，多项研究强调了衰弱综合征在决定接受心脏手术老年患者预后方面的作用。特别是，一些功能方面，如步速，在这方面似乎具有很高的敏感性和特异性。因此，不仅需要进一步研究以确定一种独特、快速且易于使用的工具来识别衰弱综合征，而且主要是能够为我们提供有关针对性术前干预效果的信息。最后，我们需要有科学数据，了解手术、经皮和经导管手术在老年患者围手术期死亡率、术后生活质量以及衰弱可能的可逆性方面对结局的作用。心血管手术迄今为止是一个“移动靶标”，这是由于患者情况不断变化以及技术要求和围手术期管理不断变化，围手术期管理应反映这些变化。
