Christakis G T, Weisel R D, David T E, Salerno T A, Ivanov J
Division of Cardiovascular Surgery, University of Toronto, Ontario, Canada.
Circulation. 1988 Sep;78(3 Pt 2):I25-34.
To identify the independent predictors of operative mortality, we examined 31 preoperative clinical and hemodynamic variables in 2,488 patients undergoing valvular surgery between 1982 and 1986. The operative mortality was 5.3% in 1,098 patients after aortic valve surgery, 6.6% in 1,107 after mitral valve surgery, and 10.1% in 283 after double valve surgery. Multivariate statistical analysis demonstrated that urgent surgery, endocarditis requiring urgent surgery, previous aortic valve surgery, coronary artery disease, and age were independent risk factors for aortic valve surgery. Urgent surgery, endocarditis, age, coronary artery disease, and preoperative ventricular ejection fraction were independent predictors of mortality after mitral valve surgery. The predictors of mortality after double valve surgery were urgent surgery, age, preoperative ventricular ejection fraction, and tricuspid valve disease. Gender and the type of valvular lesion, procedure, and prosthesis did not independently influence operative mortality. Strategies to diminish operative mortality should include careful assessment of the risks and benefits in elderly patients, early operative intervention before deterioration that necessitates urgent surgery, and use of improved techniques of myocardial protection in high-risk subgroups.
为确定手术死亡率的独立预测因素，我们研究了1982年至1986年间接受瓣膜手术的2488例患者的31项术前临床和血流动力学变量。1098例主动脉瓣手术后患者的手术死亡率为5.3%，1107例二尖瓣手术后患者的手术死亡率为6.6%，283例双瓣膜手术后患者的手术死亡率为10.1%。多变量统计分析表明，急诊手术、需急诊手术的感染性心内膜炎、既往主动脉瓣手术、冠状动脉疾病和年龄是主动脉瓣手术的独立危险因素。急诊手术、感染性心内膜炎、年龄、冠状动脉疾病和术前心室射血分数是二尖瓣手术后死亡率的独立预测因素。双瓣膜手术后死亡率的预测因素为急诊手术、年龄、术前心室射血分数和三尖瓣疾病。性别、瓣膜病变类型、手术方式和人工瓣膜并未独立影响手术死亡率。降低手术死亡率的策略应包括仔细评估老年患者的风险和益处、在病情恶化需要急诊手术之前尽早进行手术干预，以及在高危亚组中采用改进的心肌保护技术。
