Di Biasi P, Scrofani R, Moriggia S, Di Mattia D, Mangini A, Santoli C
Divisione di Chirurgia Toracica e Cardiovascolare, Ospedale Luigi Sacco, Milano.
G Ital Cardiol. 1995 Sep;25(9):1139-44.
Since September 1985 to June 1994, 252 patients (70 years and older) underwent coronary artery bypass grafting isolated or combined with other surgical procedures. Mean age was 73 +/- 4.3 years (range: 70-84). Associated non-cardiac diseases were present in 131 patients (52%). Concomitant surgical procedures were performed in 34 patients (13.5%). Myocardial revascularization was accomplished under emergency conditions in 18.1% of patients. Overall operative mortality was 5.5% (n = 14). Isolated coronary artery bypass grafting operative mortality was 3.9% (n = 10). In-hospital death rate was higher (11.7%; n = 4) for coronary artery bypass grafting associated with other procedures. During the same period, the overall mortality rate for patients younger than 70 years was 3.4% (p = NS). The 30-days in-hospital mortality was significantly higher for emergency procedures (8.7%) than for elective surgery (4.9%) (p = 0.01). Multivariate stepwise logistic regression analysis identified concomitant diseases as independently significant risk factor. Morbidity was 36.1% (n = 91). Mean intensive care unit stay was 2.8 +/- 2.2 days vs 2.1 +/- 1.2 days for patients < 70 years (p = 0.01). Total charges per case for surgical treatment were 15% higher for elderly patients. Follow up ranged from 1 to 108 months, averaging 32 months. Long-term survival was 92%, 78% and 58% at 1, 5 and 10 years from operation. With current techniques, cardiac surgery is performed in the elderly with acceptable mortality and morbidity and with slightly increased average costs.
1985年9月至1994年6月，252例（年龄在70岁及以上）患者接受了单纯冠状动脉旁路移植术或联合其他外科手术。平均年龄为73±4.3岁（范围：70 - 84岁）。131例（52%）患者存在相关非心脏疾病。34例（13.5%）患者进行了同期外科手术。18.1%的患者在紧急情况下完成了心肌血运重建。总体手术死亡率为5.5%（n = 14）。单纯冠状动脉旁路移植术的手术死亡率为3.9%（n = 10）。与其他手术联合的冠状动脉旁路移植术的住院死亡率更高（11.7%；n = 4）。同期，70岁以下患者的总体死亡率为3.4%（p = 无显著性差异）。急诊手术的30天住院死亡率（8.7%）显著高于择期手术（4.9%）（p = 0.01）。多因素逐步逻辑回归分析确定合并疾病是独立的显著危险因素。发病率为36.1%（n = 91）。重症监护病房平均住院时间为2.8±2.2天，而70岁以下患者为2.1±1.2天（p = 0.01）。老年患者每例手术治疗的总费用高出15%。随访时间为1至108个月，平均32个月。术后1年、5年和10年的长期生存率分别为92%、78%和58%。采用当前技术，老年患者进行心脏手术的死亡率和发病率可接受，平均费用略有增加。
