Weintraub R M, Wei J Y, Thurer R L
J Am Geriatr Soc. 1986 May;34(5):389-92. doi: 10.1111/j.1532-5415.1986.tb04323.x.
The in-hospital mortality associated with acute myocardial infarction rises markedly with advancing age. It is not established whether the elderly may benefit from early surgical repair of postinfarction cardiogenic shock due to ventricular septal defect (VSD), acute severe mitral regurgitation (MR), or left ventricular power failure. Eighteen consecutive patients between the ages of 66 and 79 (mean, 72 years) and in cardiogenic shock underwent surgical repair, most with counterpulsation support, within one week of developing VSD, MR, or left ventricular power failure. Of ten patients with VSD, five (50%) survived. Three of seven patients with MR (43%) and the only patient with power failure survived for an overall survival of 50%. The nine long-term survivors were followed up for six months to five years (mean 31 months) by personal interviews with the patient or referring physician. There was one late death, due to congestive heart failure, ten months after the operation. Of the remaining eight patients, seven are categorized as New York Heart Association class I, and one as class II. These patients have all been able to live and function independently after cardiac operation. The authors conclude that older patients with postinfarction cardiogenic shock may benefit from early operation and that advanced age does not preclude successful surgical outcome. Furthermore, operation may result in excellent long-term quality of life.
急性心肌梗死相关的院内死亡率随年龄增长显著上升。目前尚不清楚老年人是否能从早期手术修复因室间隔缺损（VSD）、急性严重二尖瓣反流（MR）或左心室衰竭导致的心肌梗死后心源性休克中获益。18例年龄在66至79岁（平均72岁）且处于心源性休克的患者，在发生VSD、MR或左心室衰竭后的一周内接受了手术修复，大多数患者接受了反搏支持。10例VSD患者中，5例（50%）存活。7例MR患者中有3例（43%）存活，唯一1例左心室衰竭患者存活，总体存活率为50%。9例长期存活者通过对患者本人或转诊医生进行个人访谈，随访了6个月至5年（平均31个月）。术后10个月有1例因充血性心力衰竭晚期死亡。其余8例患者中，7例被归类为纽约心脏协会I级，1例为II级。这些患者在心脏手术后均能够独立生活和正常活动。作者得出结论，心肌梗死后心源性休克的老年患者可能从早期手术中获益，高龄并不排除手术成功的结果。此外，手术可能带来极佳的长期生活质量。
