de Mol B A, Kallewaard M, Lewin F, van Gaalen G L, van den Brink R B
Department of Cardiopulmonary Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
Eur J Cardiothorac Surg. 1997 Aug;12(2):285-90. doi: 10.1016/s1010-7940(97)00103-6.
To determine short- and long-term outcome of open-heart surgery in octogenarians.
We reviewed the medical charts of 130 consecutive octogenarians undergoing open-heart surgery. Patients with significant comorbidity were excluded from the study. The effect of cardiac and operative risk factors on mortality and morbidity was evaluated. General practitioners and cardiologists were contacted in order to obtain information on the patients' current medical and functional status.
Operative mortality for valve replacement (VR) and coronary artery bypass grafting (CABG) was 11.5%. Four-year survival was 73.5% with 75.9% still living independently. The relative risk for operative mortality was 4.3 in case of extracorporeal bypass time exceeding 95 min and 3.6 in case of significant left main stem disease. The risk of late death increased 2.5 times at a left ventricular ejection fraction lower than 50%.
Our data match the results of similar studies involving large numbers of patients. When a multicenter data bank is missing, the evaluation of a relatively small patient group can yield information that may be as useful to patient and physician as information obtained by large studies. Open-heart surgery in octogenarians carries an acceptable mortality risk and its effectiveness in terms of improved quality of life is good.
确定八旬老人心脏直视手术的短期和长期结果。
我们回顾了130例连续接受心脏直视手术的八旬老人的病历。有严重合并症的患者被排除在研究之外。评估心脏和手术风险因素对死亡率和发病率的影响。联系全科医生和心脏病专家以获取患者当前医疗和功能状况的信息。
瓣膜置换术（VR）和冠状动脉旁路移植术（CABG）的手术死亡率为11.5%。四年生存率为73.5%，其中75.9%仍能独立生活。体外循环时间超过95分钟时手术死亡的相对风险为4.3，左主干严重病变时为3.6。左心室射血分数低于50%时，晚期死亡风险增加2.5倍。
我们的数据与涉及大量患者的类似研究结果相符。当缺乏多中心数据库时，对相对较小患者群体的评估所产生的信息，对患者和医生可能与大型研究所获得的信息一样有用。八旬老人心脏直视手术的死亡风险可接受，且在改善生活质量方面效果良好。
