Taghizadeh-Waghefi Ali, Petrov Asen, Arzt Sebastian, Alexiou Konstantin, Tugtekin Sems-Malte, Matschke Klaus, Kappert Utz, Wilbring Manuel
Medical Faculty "Carl Gustav Carus", Technical University of Dresden, 01307 Dresden, Germany.
Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany.
J Clin Med. 2024 Jan 27;13(3):745. doi: 10.3390/jcm13030745.
(1) Background: this study addresses the lack of comprehensive research on outcomes in octogenarians undergoing cardiac surgery for multivalvular disease, emphasizing the need for a critical examination of the intervention's overall worth in this aging population. (2) Methods: By analyzing short-term and mid-term data from 101 consecutive octogenarian patients undergoing multivalve surgery, the study identifies predictors for in-hospital and one-year mortality. (3) Results: In-hospital mortality increased fourfold with the occurrence of at least one postoperative complication. Octogenarians undergoing multivalve surgery experienced an in-hospital mortality rate of 13.9% and an overall one-year mortality rate of 43.8%. Postoperative delirium was identified as an independent risk factor, contributing to elevated risks of both in-hospital and one-year mortality. Prolonged surgical procedure time emerged as an independent risk factor associated with increased in-hospital mortality. Continuous veno-venous hemodialysis showed an independent impact on in-hospital mortality. Both re-intubation and the transfusion of packed red blood cells were identified as independent risk factors for one-year mortality. (4) Conclusions: This study urges a critical examination of the justification for multivalve surgeries in high-risk elderly patients, emphasizing a paradigm shift. It advocates for interdisciplinary collaboration and innovative strategies, such as staged hybrid procedures, to improve therapeutic approaches for this challenging patient group to achieve a better therapeutic outcome for these patients.
（1）背景：本研究针对八十岁以上老人接受多瓣膜疾病心脏手术的结果缺乏全面研究的情况，强调有必要对这一年龄段人群中该干预措施的整体价值进行批判性审视。（2）方法：通过分析101例连续接受多瓣膜手术的八十岁以上老人的短期和中期数据，本研究确定了院内和一年死亡率的预测因素。（3）结果：至少出现一种术后并发症时，院内死亡率增加四倍。接受多瓣膜手术的八十岁以上老人的院内死亡率为13.9%，一年总死亡率为43.8%。术后谵妄被确定为独立危险因素，会增加院内和一年死亡率。手术时间延长是与院内死亡率增加相关的独立危险因素。持续静脉-静脉血液透析对院内死亡率有独立影响。再次插管和输注浓缩红细胞均被确定为一年死亡率的独立危险因素。（4）结论：本研究敦促对高危老年患者进行多瓣膜手术的合理性进行批判性审视，强调范式转变。它提倡跨学科合作和创新策略，如分期杂交手术，以改善针对这一具有挑战性患者群体的治疗方法，为这些患者实现更好的治疗效果。
