O'Keefe J H, Vlietstra R E, Bailey K R, Holmes D R
Division of Cardiovascular, Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
Mayo Clin Proc. 1987 Nov;62(11):986-91. doi: 10.1016/s0025-6196(12)65068-x.
Recently, balloon aortic valvuloplasty has been proposed for the treatment of severe aortic stenosis in elderly patients when aortic valve replacement has been declined or deferred. The natural history of these patients has not been clearly defined. Therefore, to develop a comparison cohort of patients with unoperated aortic stenosis, we reviewed the records of all Mayo Clinic patients in whom severe aortic stenosis had been diagnosed during the period 1978 through 1985 but no surgical procedure had been performed because the patient declined or the physician deferred this option. Among the 50 patients identified (36 men and 14 women; mean age 77 years, range 60 to 89 years), an operation was declined by 28 and deferred in 22. The diagnosis of aortic stenosis was established clinically by a cardiologist in all 50 patients and independently confirmed by echocardiography, Doppler ultrasonography, or catheterization in 47 of the 50. All patients were symptomatic. Follow-up was complete to September 1986 or death in all 50 patients. Actuarial survival at 1, 2, and 3 years was 57, 37, and 25%, respectively. Survival of age- and sex-matched control subjects was 93, 85, and 77%, respectively (P less than 0.0001 at each 1-year interval). At last follow-up, only 13 of the 50 patients (26%) were alive. A cardiac cause was cited for 36 of the 37 deaths. Because of the poor survival in this group of patients, evaluation of alternative nonsurgical therapeutic modalities such as balloon valvuloplasty is imperative when operative intervention is declined or deferred in elderly patients.
最近，对于那些拒绝或推迟进行主动脉瓣置换术的老年严重主动脉瓣狭窄患者，有人提出采用球囊主动脉瓣成形术进行治疗。这些患者的自然病程尚未明确界定。因此，为了建立一个未经手术治疗的主动脉瓣狭窄患者的对照队列，我们回顾了梅奥诊所1978年至1985年期间所有被诊断为严重主动脉瓣狭窄但因患者拒绝或医生推迟手术而未进行任何外科手术的患者记录。在确定的50例患者中（36例男性和14例女性；平均年龄77岁，范围60至89岁），28例拒绝手术，22例推迟手术。所有50例患者的主动脉瓣狭窄诊断均由心脏病专家临床确定，其中47例经超声心动图、多普勒超声或心导管检查独立证实。所有患者均有症状。对所有50例患者的随访至1986年9月或死亡时为止。1年、2年和3年的精算生存率分别为57%、37%和25%。年龄和性别匹配的对照受试者的生存率分别为93%、85%和77%（每1年间隔P均小于0.0001）。在最后一次随访时，50例患者中仅13例（26%）存活。37例死亡中有36例归因于心脏原因。由于该组患者生存率较低，当老年患者拒绝或推迟手术干预时，评估球囊瓣膜成形术等替代性非手术治疗方式势在必行。
