Akins C W, Daggett W M, Vlahakes G J, Hilgenberg A D, Torchiana D F, Madsen J C, Buckley M J
Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
Ann Thorac Surg. 1997 Sep;64(3):606-14; discussion 614-5. doi: 10.1016/s0003-4975(97)00615-2.
Because the elderly are increasingly referred for operation, we reviewed results with cardiac surgical patients 80 years old or older.
Records of 600 consecutive patients 80 years old or older having cardiac operations between 1985 and 1995 were reviewed. Follow-up was 99% complete.
Two hundred ninety-two patients had coronary grafting (CABG), 105 aortic valve replacement (AVR), 111 AVR + CABG, 42 mitral valve repair/ replacement (MVR) +/- CABG, and 50 other operations. Rates of hospital death, stroke, and prolonged stay (> 14 days) were as follows: CABG: 17 (5.8%), 23 (7.9%) and 91 (31.2%); AVR: 8 (7.6%), 1 (1.0%), and 31 (29.5%); AVR + CABG: 7 (6.3%), 12 (10.8%), and 57 (51.4%); MVR +/- CABG: 4 (9.5%), 3 (7.1%), and 16 (38.1%); other: 9 (18.0%), 3 (6.0%), and 23 (46.0%). Multivariate predictors (p < 0.05) of hospital death were chronic lung disease, postoperative stroke, preoperative intraaortic balloon, and congestive heart failure; predictors of stroke were CABG and carotid disease; and predictors of prolonged stay were postoperative stroke and New York Heart Association class. Actuarial 5-year survival was as follows: CABG, 66%; AVR, 67%; AVR + CABG, 59%; MVR +/- CABG, 57%; other, 48%; and total, 63%. Multivariate predictors of late death were renal insufficiency, postoperative stroke, chronic lung disease, and congestive heart failure. Eighty-seven percent of patients believed having a heart operation after age 80 years was a good choice.
Cardiac operations are successful in most octogenarians with increased hospital mortality, postoperative stroke, and longer hospital stay. Long-term survival is largely determined by concurrent medical diseases.
由于越来越多的老年人接受手术治疗，我们回顾了80岁及以上心脏手术患者的治疗结果。
回顾了1985年至1995年间连续600例80岁及以上接受心脏手术患者的记录。随访完成率为99%。
292例患者接受冠状动脉搭桥术（CABG），105例接受主动脉瓣置换术（AVR），111例接受AVR+CABG，42例接受二尖瓣修复/置换术（MVR）+/-CABG，50例接受其他手术。住院死亡率、中风发生率和住院时间延长（>14天）的情况如下：CABG：17例（5.8%）、23例（7.9%）和91例（31.2%）；AVR：8例（7.6%）、1例（1.0%）和31例（29.5%）；AVR+CABG：7例（6.3%）、12例（10.8%）和57例（51.4%）；MVR+/-CABG：4例（9.5%）、3例（7.1%）和16例（38.1%）；其他：9例（18.0%）、3例（6.0%）和23例（46.0%）。住院死亡的多因素预测因素（p<0.05）为慢性肺病、术后中风、术前主动脉内球囊反搏和充血性心力衰竭；中风的预测因素为CABG和颈动脉疾病；住院时间延长的预测因素为术后中风和纽约心脏协会心功能分级。5年精算生存率如下：CABG为66%；AVR为67%；AVR+CABG为59%；MVR+/-CABG为57%；其他为48%；总体为63%。晚期死亡的多因素预测因素为肾功能不全、术后中风、慢性肺病和充血性心力衰竭。87%的患者认为80岁以后进行心脏手术是一个不错的选择。
大多数八旬老人心脏手术成功，但住院死亡率、术后中风发生率增加，住院时间延长。长期生存很大程度上取决于并存的内科疾病。
