Comet B, Elkouby A, Vaillant A, Lafay V, Massiani P F, Malmejac C, Houel J
Clinique de chirurgie thoracique, Centre Jules-Cantini, Marseille.
Arch Mal Coeur Vaiss. 1988 Jan;81(1):81-8.
The ever increasing age of the general population and the frequency of coronary and aortic lesions in patients aged 70 or older make cardiac surgery in the elderly a topic of current interest. In a retrospective study of 170 cases the overall mortality rate was 14 p. 100 (4.7 p. 100 in 1986). During the past two years (1985 and 1986), the mortality rates in patients with coronary disease who underwent elective surgery were 10 p. 100 and 4 p. 100 respectively. Emergency surgery (left coronary trunk and unstable angina excluded) and associated operations on the heart made the prognosis worse with overall mortality rates of 13 p. 100 and 15 p. 100 respectively (9 p. 100 in 1985, 10 p. 100 in 1986). In aortic valve surgery, hospital mortality rates were 28 p. 100 in 1985 and 6 p. 100 in 1986. Post-operative morbidity was high (52 p. 100 of patients) and consisted mostly of respiratory and neurological complications (14.7 p. 100 and 9.4 p. 100 respectively of all patients). Only 4 p. 100 of the patients developed peri-operative myocardial infarction. Functional results were satisfactory in both coronary disease and heart valve disease patients. The survival rate at 4 years was 74.5 +/- 10 p. 100 globally and 87.3 +/- 9 p. 100 in coronary patients operated upon electively. Thus, the considerable advances in surgical techniques and post-operative intensive care achieved during the last few years have significantly improved the results obtained in this population.(ABSTRACT TRUNCATED AT 250 WORDS)
普通人群年龄不断增加,70岁及以上患者冠状动脉和主动脉病变的发生率不断上升,使得老年心脏手术成为当前备受关注的话题。在一项对170例患者的回顾性研究中,总体死亡率为14‰(1986年为4.7‰)。在过去两年(1985年和1986年),接受择期手术的冠心病患者死亡率分别为10‰和4‰。急诊手术(不包括左冠状动脉主干和不稳定型心绞痛)以及心脏相关手术使预后更差,总体死亡率分别为13‰和15‰(1985年为9‰,1986年为10‰)。在主动脉瓣手术中,1985年医院死亡率为28‰,1986年为6‰。术后发病率较高(52%的患者),主要包括呼吸和神经并发症(分别占所有患者的14.7%和9.4%)。仅4%的患者发生围手术期心肌梗死。冠心病和心脏瓣膜病患者的功能结果均令人满意。全球4年生存率为74.5±10%,择期手术的冠心病患者4年生存率为87.3±9%。因此,过去几年在手术技术和术后重症监护方面取得的显著进展显著改善了该人群的治疗效果。(摘要截取自250字)