Department of Cardiovascular Surgery of Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
Department of Cardiovascular Surgery of Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China.
Surg Today. 2021 Sep;51(9):1471-1479. doi: 10.1007/s00595-021-02272-y. Epub 2021 Apr 13.
A previous study reported that the ventricular septum is more fragile in geriatric patients, and thus myectomy may expose geriatric patients to a higher risk of serious complications. This single-center study evaluates the impacts of the advanced age on the results following myectomy for symptomatic hypertrophic obstructive cardiomyopathy (HOCM).
All eligible patients were divided into an elderly group (septuagenarians, n = 35) and a control group (patients under 70 years, n = 197). The patients were followed up for a median of 10 months. Thereafter, the perioperative and follow-up results were compared.
Thirteen patients (8.6% for the elderly group and 5.1% for the control group, p = 0.422) underwent immediate repeat surgery. Surgical mortality did not differ between groups (0 vs. 0.5%, p > 0.05). There was no significant difference in the incidence of complete atrioventricular block between groups (5.7 vs. 3.0%, p = 0.346). No follow-up deaths occurred in either group. The maximum gradients at the latest follow-up were significantly lower than the preoperative values in either group. Additionally, grouping (septuagenarians vs. patients under 70 years of age) was not an independent risk factor for surgical complications and results via multivariable logistic regression.
Septuagenarians with HOCM may obtain favorable results following septal myectomy, the same as did HOCM patients under 70 years of age.
先前的研究报告称，老年患者的室间隔更脆弱，因此心肌切除术可能使老年患者面临更高的严重并发症风险。本单中心研究评估了高龄对接受心肌切除术的有症状肥厚型梗阻性心肌病（HOCM）患者结果的影响。
所有符合条件的患者被分为老年组（70 岁以上，n = 35）和对照组（70 岁以下，n = 197）。患者的中位随访时间为 10 个月。之后，比较了围手术期和随访结果。
13 名患者（老年组 8.6%，对照组 5.1%，p = 0.422）需要立即再次手术。两组的手术死亡率无差异（0%比 0.5%，p > 0.05）。两组完全性房室传导阻滞的发生率也无差异（5.7%比 3.0%，p = 0.346）。两组均无随访死亡。两组的最大梯度在随访时均显著低于术前值。此外，多变量逻辑回归分析显示，分组（70 岁以上与 70 岁以下）不是手术并发症和结果的独立危险因素。
HOCM 高龄患者接受室间隔切除术可能获得与 70 岁以下 HOCM 患者相同的良好结果。
