Ji Qiang, Qi Xiao-Min, Shen Jin-Qiang, Wang Yu-Lin, Yang Ye, Ding Wen-Jun, Xia Li-Min, Wang Chun-Sheng
Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, Shanghai 200032, China.
Shanghai Municipal Institute of Cardiovascular Diseases, Shanghai 200032, China.
Cardiovasc Diagn Ther. 2019 Dec;9(6):568-577. doi: 10.21037/cdt.2019.10.06.
Elderly patients, compared with the young, have a higher burden of surgical risk factors with reduced functional capacity and increased comorbidities conditions, and may have worse clinical outcomes. So far, few reports have focused on clinical outcomes of patients over 70 years of age with moderate chronic ischemic mitral regurgitation (IMR) undergoing mitral valve repair at the time of coronary artery bypass grafting (CABG). This single-center study of propensity-matched data attempts to answer a question: compared with patients with age of 70 or less, whether patients over 70 years of age with moderate IMR undergoing CABG plus mitral valve repair receive poor outcomes.
All eligible patients were included in this study and were entered into either an elderly group (n=142) or a control group (n=182) according to patients' age. In-hospital outcomes (consisting of surgical mortality and major postoperative morbidity) and midterm clinical outcomes (including all-cause mortality and recurrent mitral regurgitation) were compared after propensity score matching (1:1).
Using propensity-score matching, 103 pairs of patients were successfully established in a 1:1 ratio. No significant differences between the two matched groups were found with regard to surgical mortality (5.8% 3.9%, P=0.754) and major postoperative morbidity. A total of 184 patients (91 in the elderly group and 93 in the control group) received regular follow-up visit with the median duration of 38 months [interquartile range (IQR), 27-56 months]. There were not any significant differences between the two matched groups regarding overall survival and recurrent IMR-free survival (stratified log-rank P=0.185 and stratified log-rank P=0.453, respectively). The elderly group as compared to the control group did not affect midterm mortality via cox proportional hazard regression (propensity score adjusted hazard ratio, 1.143; 95% confidence interval, 0.761-1.943; P=0.285).
Patients over 70 years of age with moderate chronic IMR undergoing combined CABG and mitral valve repair may receive favorable in-hospital and midterm clinical outcomes.
与年轻患者相比，老年患者手术风险因素负担更高，功能能力下降且合并症增加，临床结局可能更差。迄今为止，很少有报告关注70岁以上中度慢性缺血性二尖瓣反流（IMR）患者在冠状动脉旁路移植术（CABG）时接受二尖瓣修复的临床结局。这项对倾向匹配数据的单中心研究试图回答一个问题：与70岁及以下患者相比，70岁以上中度IMR患者在接受CABG加二尖瓣修复时是否会有不良结局。
所有符合条件的患者均纳入本研究，并根据患者年龄分为老年组（n = 142）或对照组（n = 182）。在倾向得分匹配（1:1）后，比较住院结局（包括手术死亡率和术后主要并发症）和中期临床结局（包括全因死亡率和二尖瓣反流复发）。
采用倾向得分匹配，成功建立了103对1:1比例的患者。在手术死亡率（5.8%对3.9%，P = 0.754）和术后主要并发症方面，两个匹配组之间未发现显著差异。共有184例患者（老年组91例，对照组93例）接受了定期随访，中位随访时间为38个月[四分位间距（IQR），27 - 56个月]。在总生存率和无二尖瓣反流复发生存率方面，两个匹配组之间没有任何显著差异（分层对数秩检验P分别为0.185和0.453）。与对照组相比，老年组通过Cox比例风险回归未影响中期死亡率（倾向得分调整风险比，1.143；95%置信区间为0.761 - 1.943；P = 0.285）。
70岁以上中度慢性IMR患者接受CABG联合二尖瓣修复可能获得良好的住院和中期临床结局。
