Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal.
Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal.
Rev Port Cardiol. 2024 Jun;43(6):311-320. doi: 10.1016/j.repc.2024.02.003. Epub 2024 Feb 22.
Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%).
A retrospective observational single-center cohort study with 195 patients aged ≥80 years old, who underwent SAVR between 2017 and 2021, was conducted. Patients were divided into two groups according to EuroscoreII: (1) Low risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Continuous variables are presented in median (IQR), analyzed using Wilcoxon rank sum test; categorical variables in percentages, analyzed using chi-squared test; and survival was analyzed by Kaplan-Meier, open cohort, and the log-rank test was performed.
The overall median age was 82 (IQR 81-83), with 4.6% of the patients ≥85 years old. 23.6% of the patients presented EuroscoreII ≥4%. No complications were observed in 26.2%, with a significantly higher rate in intermediate-high risk patients. Postoperative need for hemodynamic support was the most frequent complication, followed by postoperative acute kidney injury and the use of blood products. Overall median ICU stay was three days (2-4) and hospital length of stay (LOS) six days (5-8). Patients with intermediate-high risk and those with complications had longer ICU LOS. At 12 months, overall survival was 96.4%, at three years 94.1% and 5 years 75.4%. Patients with low surgical risk had higher survival proportions up to 5 years.
SAVR in patients ≥80 years is associated with low in-hospital mortality, although a significant proportion of patients develop complications. Long-term follow-up up to five years after surgery is acceptable in octogenarians with low surgical risk.
主动脉瓣狭窄是最常见的心脏瓣膜病。由于预期寿命的延长，建议接受介入治疗的 80 岁以上患者数量不断增加。在本研究中，我们旨在评估 80 岁以上患者行主动脉瓣置换术（SAVR）的围手术期结果和长期生存率，并比较低手术风险（EuroscoreII<4%）与中高危风险（EuroscoreII≥4%）患者的结果。
我们进行了一项回顾性观察性单中心队列研究，纳入了 195 名 2017 年至 2021 年间接受 SAVR 的年龄≥80 岁的患者。根据 EuroscoreII 将患者分为两组：（1）低危组（EuroscoreII<4%）与中高危组（EuroscoreII≥4%）。连续变量以中位数（IQR）表示，采用 Wilcoxon 秩和检验进行分析；分类变量以百分比表示，采用卡方检验进行分析；采用 Kaplan-Meier 法进行生存分析，开放队列，并进行对数秩检验。
总体中位数年龄为 82（IQR 81-83），其中 4.6%的患者≥85 岁。23.6%的患者 EuroscoreII≥4%。无并发症的患者占 26.2%，中高危组患者的发生率明显更高。术后需要血流动力学支持是最常见的并发症，其次是术后急性肾损伤和血液制品的使用。总体 ICU 中位住院时间为 3 天（2-4 天），医院中位住院时间为 6 天（5-8 天）。中高危组和有并发症的患者 ICU 住院时间较长。12 个月时，总生存率为 96.4%，3 年生存率为 94.1%，5 年生存率为 75.4%。低手术风险患者 5 年内的生存率更高。
SAVR 在 80 岁以上患者中与院内死亡率低相关，尽管有相当一部分患者出现并发症。在低手术风险的 80 岁以上患者中，术后 5 年的长期随访是可以接受的。
