Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Poznan, Poland, Długa 1/ 2, 61-848 Poznan, Poland.
Kardiol Pol. 2018;76(3):655-661. doi: 10.5603/KP.2018.0005. Epub 2018 Jan 9.
Aortic stenosis and coronary artery disease (CAD) sharing similar risk factors are associated with aging of the human population.
The purpose of this study was to examine whether age affects clinical presentation, intraoperative management, and outcomes of patients who undergo simultaneous operations of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).
The study involved 452 consecutive patients aged 64.8 ± 8.2 years (range 38-79 years), who underwent combined AVR and CABG between 2005 and 2015. They were divided into three groups: Y (young; below the first quartile; n = 114), M (middle-aged; 58-71 years; n = 225) and E (elderly; above the third quartile; n = 113). Pre- and intraoperative variables were analysed. The deaths that occurred in hospital and throughout follow-up were defined as cardiac- or non-cardiac-related. The probability of survival was calculated with the use of Kaplan-Meier curves.
Coronary artery disease was more extensive in group E than in group Y (p < 0.05). Complete myocardial revasculari-sation was performed in 94.1%, 76.2%, and 62.8% in groups Y, M, and E, respectively (p < 0.05). In-hospital mortality was 2.0%, 5.3%, and 6.4%, in groups Y, M, and E, respectively. Early morbidity was significantly higher in group E than in groups M or Y. The 12- and 60-month freedom from cardiac-related death was higher in group Y (0.98 ± 0.02 and 0.94 ± 0.03) than in group E (0.93 ± 0.02 and 0.85 ± 0.03; p = 0.023, respectively). Left ventricular ejection fraction below 0.4 and incomplete revascularisation were associated with worse prognosis, particularly in group E.
Elderly patients undergoing combined procedures of AVR and CABG having more extensive CAD less often receive complete revascularisation, are at higher risk of early organ failure, and present markedly reduced rates of freedom from cardiac-related deaths throughout follow-up than younger subjects.
主动脉瓣狭窄和冠状动脉疾病（CAD）具有相似的危险因素，随着人口老龄化而增加。
本研究旨在探讨年龄是否影响同时行主动脉瓣置换术（AVR）和冠状动脉旁路移植术（CABG）的患者的临床表现、术中管理和结局。
本研究纳入了 452 例年龄 64.8±8.2 岁（38-79 岁）的连续患者，这些患者在 2005 年至 2015 年间接受了 AVR 和 CABG 的联合治疗。他们被分为三组：Y 组（年轻组；低于第一四分位数；n=114）、M 组（中年组；58-71 岁；n=225）和 E 组（老年组；高于第三四分位数；n=113）。分析了术前和术中变量。将住院期间和随访期间发生的死亡定义为心脏相关或非心脏相关死亡。使用 Kaplan-Meier 曲线计算生存率。
E 组的冠状动脉疾病比 Y 组更为广泛（p<0.05）。Y、M 和 E 组的完全心肌再血管化率分别为 94.1%、76.2%和 62.8%（p<0.05）。Y、M 和 E 组的住院死亡率分别为 2.0%、5.3%和 6.4%。E 组的早期发病率明显高于 M 组和 Y 组。Y 组的 12 个月和 60 个月心脏相关死亡率无事件生存率分别为 0.98±0.02 和 0.94±0.03，高于 E 组的 0.93±0.02 和 0.85±0.03（p=0.023）。左心室射血分数低于 0.4 和不完全再血管化与预后较差相关，尤其是在 E 组。
行 AVR 和 CABG 联合手术的老年患者 CAD 更为广泛，他们接受完全再血管化的可能性较小，早期器官衰竭的风险较高，并且在随访期间的心脏相关死亡率无事件生存率明显低于年轻患者。
