Edmunds L H, Stephenson L W, Edie R N, Ratcliffe M B
Department of Surgery, School of Medicine, University of Pennsylvania, Philadelphia 19104.
N Engl J Med. 1988 Jul 21;319(3):131-6. doi: 10.1056/NEJM198807213190302.
One hundred consecutive patients 80 years of age or older consented to and subsequently underwent open-heart operations at our institution between July 1976 and May 1987. Fifty of the patients had aortic valvular disease (28 with coexisting coronary artery disease), and 41 had isolated coronary artery disease. Eight patients had mitral valvular disease, and one had a dissecting aortic aneurysm. Ninety had Class IV disease that was functional, ischemic, or both. The most compelling indications for operation in 85 patients were unstable or postinfarction angina, syncope, acute pulmonary edema, or cardiogenic shock. Twenty-nine patients died soon after operation (within 90 days). New York Heart Association Class IV disease, previous myocardial infarction, cachexia, and emergency operation were preoperative variables associated with early death. Forty-three patients had no complications except for atrial arrhythmias and were discharged from the hospital a mean (+/- SD) of 11.5 +/- 3.7 days after operation. Low cardiac output, acute myocardial infarction, reoperation for bleeding, renal insufficiency, pneumonia, and prolonged endotracheal intubation were the most common serious postoperative complications. Twenty-eight patients who survived postoperative complications were discharged 24.9 +/- 19.6 days after operation. Seventeen patients died 2 to 104 months after discharge from the hospital. Actuarial calculation predicts the survival of 59 percent of patients at three years and 54 percent at five years. Of the 54 patients still alive at this writing, 53 have disease within New York Heart Association and Canadian Cardiovascular Society Classes I or II. For selected octogenarians with unmanageable cardiac symptoms, operation may be an effective therapeutic option.
1976年7月至1987年5月期间，100例连续入选的80岁及以上患者同意并随后在我们机构接受了心脏直视手术。其中50例患者患有主动脉瓣疾病（28例合并冠状动脉疾病），41例患有孤立性冠状动脉疾病。8例患者患有二尖瓣疾病，1例患有主动脉夹层动脉瘤。90例患者有IV级功能性、缺血性或两者兼具的疾病。85例患者最主要的手术指征是不稳定型或梗死后心绞痛、晕厥、急性肺水肿或心源性休克。29例患者术后不久（90天内）死亡。纽约心脏协会IV级疾病、既往心肌梗死、恶病质和急诊手术是与早期死亡相关的术前变量。43例患者除房性心律失常外无其他并发症，术后平均（±标准差）11.5±3.7天出院。低心排血量、急性心肌梗死、因出血再次手术、肾功能不全、肺炎和长时间气管插管是最常见的严重术后并发症。28例术后存活的患者术后24.9±19.6天出院。17例患者在出院后2至104个月死亡。精算计算预测三年生存率为59%，五年生存率为54%。在撰写本文时仍存活的54例患者中，53例患有纽约心脏协会和加拿大心血管学会I级或II级疾病。对于选定的有难以控制的心脏症状的八旬老人，手术可能是一种有效的治疗选择。
