Barbero Cristina, Brenna Dario, Salsano Antonio, Pocar Marco, Stura Erik Cura, Calia Claudia, Sebastiano Viviana, Rinaldi Mauro, Ricci Davide
Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy.
Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy.
J Geriatr Cardiol. 2023 Apr 28;20(4):276-283. doi: 10.26599/1671-5411.2023.04.006.
Mean age of patients with valves diseases is significantly increasing, and, in the near future, cardiac surgeons will have to deal with a considerable number of patients aged more than 80 years. The remarkable results gained by the minimally invasive approach have encouraged its application in more complex and fragile patients, such as older people. This study aimed to identify the rate of early mortality and major complications, and independent predictors for mid-term mortality in octogenarians undergoing minimally invasive valve surgery.
Octogenarian patients undergoing right mini-thoracotomy mitral and/or tricuspid valve surgery between 2006 and 2020 were included. Primary endpoint was to identify independent predictors for mid-term mortality, and secondary endpoints were operative morality, stroke, independent predictors for early composite outcome, and quality of life at follow-up.
Analysis was performed on 130 patients. Stroke occurred in one patient (0.8%), while operative mortality was 6% (eight patients). One-year and five-year survival were 86% and 64%, respectively. Logistic regression identified age and creatinine level as independent predictors of mid-term mortality, survival analysis showed that age ≥ 84 years and creatinine level ≥ 1.22 mg/dL were the cut-off points for worst prognosis. Female gender and hypertension were found to be independent predictors of early composite outcome.
Results of the present study show that age alone should not be considered a contraindication for minimally invasive valve surgery. Identifying patients who are most likely to have survival and functional benefits after surgery is decisive to achieve optimal health outcomes and prevent futile procedures.
瓣膜疾病患者的平均年龄在显著增加，在不久的将来，心脏外科医生将不得不应对大量80岁以上的患者。微创方法取得的显著成果促使其在更复杂和脆弱的患者（如老年人）中得到应用。本研究旨在确定接受微创瓣膜手术的八旬老人的早期死亡率和主要并发症发生率，以及中期死亡率的独立预测因素。
纳入2006年至2020年间接受右胸小切口二尖瓣和/或三尖瓣手术的八旬老人患者。主要终点是确定中期死亡率的独立预测因素，次要终点是手术死亡率、中风、早期综合结局的独立预测因素以及随访时的生活质量。
对130例患者进行了分析。1例患者（0.8%）发生中风，手术死亡率为6%（8例患者）。1年和5年生存率分别为86%和64%。逻辑回归确定年龄和肌酐水平为中期死亡率的独立预测因素，生存分析表明年龄≥84岁和肌酐水平≥1.22mg/dL是预后最差的临界点。发现女性性别和高血压是早期综合结局的独立预测因素。
本研究结果表明，不应仅将年龄视为微创瓣膜手术的禁忌症。识别出术后最有可能获得生存和功能益处的患者对于实现最佳健康结局和避免无效手术至关重要。
