Mullany C J, Clarebrough J K, White A L, Wilson A C
Department of Surgery, University of Melbourne, St Vincent's Hospital, Fitzroy, Victoria, Australia.
Aust N Z J Surg. 1987 Oct;57(10):733-7. doi: 10.1111/j.1445-2197.1987.tb01252.x.
Of 3254 open heart surgical cases performed since 1972, 126 patients (3.9%) were 70 years of age or older. The mean age was 72 years, the oldest being 82. Sixty-seven per cent were male. The following procedures were performed: coronary artery bypass grafting (CABG) 51, aortic valve replacement (AVR) 44, AVR + CABG 16, mitral valve replacement (MVR) 3, MVR + CABG 6, MVR + AVR 4, and other, 2. Of those undergoing CABG, 33% came from the Coronary Care Unit and 24% had left main coronary artery stenosis. There was one peri-operative death (2.0%). Of those undergoing AVR, 43% had coronary artery disease and 13% triple vessel disease. Operative mortality for AVR, and AVR + CABG was 11.4% (5/44) and 18.8% (3/16), respectively. Twenty-six per cent of operative survivors had significant postoperative complications (excluding atrial arrhythmias). The postoperative hospital stay for CABG, AVR and other cases was 11, 13 and 16 days, respectively. Seven year survival of all patients was 61.2 +/- 6.5% (+/- 1 SE) and for AVR +/- CABG was 51.5 +/- 8.6%. Five year survival for CABG was 83.9 +/- 6.3%. We conclude that, in selected cases, CABG can be performed safely in the elderly. Although valvular and combined surgery may result in significant morbidity and mortality, the satisfactory long term results in survivors justifies surgery in this group of patients.
自1972年以来共进行了3254例心脏直视手术，其中126例患者（3.9%）年龄在70岁及以上。平均年龄为72岁，年龄最大的为82岁。67%为男性。实施了以下手术：冠状动脉旁路移植术（CABG）51例、主动脉瓣置换术（AVR）44例、AVR + CABG 16例、二尖瓣置换术（MVR）3例、MVR + CABG 6例、MVR + AVR 4例，其他手术2例。在接受CABG的患者中，33%来自冠心病监护病房，24%有左主干冠状动脉狭窄。围手术期死亡1例（2.0%）。在接受AVR的患者中，43%患有冠状动脉疾病，13%患有三支血管病变。AVR以及AVR + CABG的手术死亡率分别为11.4%（5/44）和18.8%（3/16）。26%的手术幸存者有严重的术后并发症（不包括房性心律失常）。CABG、AVR和其他病例的术后住院时间分别为11天、13天和16天。所有患者的7年生存率为61.2 +/- 6.5%（+/- 1标准误），AVR +/- CABG患者的7年生存率为51.5 +/- 8.6%。CABG患者的5年生存率为83.9 +/- 6.3%。我们得出结论，在特定病例中，CABG可以在老年患者中安全进行。虽然瓣膜手术和联合手术可能导致显著的发病率和死亡率，但幸存者令人满意的长期结果证明对这组患者进行手术是合理的。
