Antunes P E, Franco C G, Oliveira J F, Antunes M J
Serviço de Cirurgia Cardiotorácica, Hospitais da Universidade, Coimbra.
Rev Port Cardiol. 1995 Feb;14(2):107-12, 103.
Previous reports on coronary artery bypass grafting in elderly patients have not usually addressed the current era of aggressive percutaneous angioplasty. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older-From May 1988 to August 1993, 158 consecutive patients in this age range (mean age 73.0 years) underwent surgical revascularization at our institution. Overall operative mortality was 4.4% (7/158), with 71.4% (5/7) of deaths due to cardiac causes. Postoperative morbidity occurred in 50.6% (80/158) of patients but was of a serious nature in only 12.0% (19/158). Surgical priority was significantly correlated with operative mortality: 1.6% (2/122) for elective cases and 17.2% (5/29) for urgent or emergency cases (p < 0.01). Univariate analysis isolated the need for postoperative inotropic support or mechanical assistance, perioperative myocardial infarction and reoperation for bleeding as significant risk factors for operative mortality (p < 0.01). Of the patients discharged from the hospital, 144 (95.4%) were followed up for a mean of 23 months (3-62). During the follow-up period there were 3 deaths, all from non cardiac causes, and 92.3% of the patients were in Canadian Cardiovascular Society class I (CCS). These results indicate that, although with somewhat higher morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting, particularly if elective revascularization is possible.
以往关于老年患者冠状动脉旁路移植术的报道通常未涉及当前积极进行经皮血管成形术的时代。为了研究这一重要的患者亚组，我们分析了我院近期对70岁及以上患者进行冠状动脉旁路移植术的经验。1988年5月至1993年8月，158例连续的该年龄段患者（平均年龄73.0岁）在我院接受了手术血运重建。总体手术死亡率为4.4%（7/158），其中71.4%（5/7）的死亡是由心脏原因导致的。50.6%（80/158）的患者出现了术后并发症，但只有12.0%（19/158）的并发症较为严重。手术优先级与手术死亡率显著相关：择期手术患者为1.6%（2/122），紧急或急诊手术患者为17.2%（5/29）（p<0.01）。单因素分析确定术后需要使用正性肌力支持或机械辅助、围手术期心肌梗死以及因出血而再次手术是手术死亡的重要危险因素（p<0.01）。出院的患者中，144例（95.4%）接受了平均23个月（3 - 62个月）的随访。在随访期间有3例死亡，均为非心脏原因，92.3%的患者处于加拿大心血管学会I级（CCS）。这些结果表明，尽管发病率和死亡率略高，但在当前高风险冠状动脉旁路移植术时代，老年患者的手术风险是可以接受的，特别是如果能够进行择期血运重建。
