高龄患者主动脉瓣置换的手术风险及疗效分析

 目的 总结高龄患者主动脉瓣置换的手术风险和远期疗效，探讨同期手术的处理原则。方法 回顾性分析61例75岁以上行主动脉瓣置换术患者的临床资料，其中男44例，女17例，年龄75~84岁［(77.5±2.1)岁］，术前心功能分级(采用美国NYHA分级) Ⅱ级11例，Ⅲ、Ⅳ级50例。根据是否合并其他手术(冠脉搭桥术等)分为单纯组和合并组。单纯组33例，合并组28例。结果 全组住院死亡率6.6% (4/61)，术后低心排是住院死亡的独立危险因素，术后主要并发症发生率45.9%。合并组体外循环时间、主动脉阻断时间长于单纯组，使用血浆的量多于单纯组；两组在住院死亡率、术后并发症发生率、术后住院时间、ICU时间、远期生存情况等方面无显著差异。出院后的随访率92.9%,随访时间2~105个月［(34±28)个月］，1、3、5、8年生存率分别为93.9%、88.7%、69.4%、41.6%。合并组与单纯组1、3、5、8年生存率分别为100%、87.5%、52.5%、52.5%与89.2%、80.3%、80.3%、40.2% (P=0.796)。结论 75岁以上高龄患者主动脉瓣置换手术死亡率及术后并发症发生率较高，但术后远期疗效满意，同期处理合并手术并不明显增加手术风险，也不影响远期疗效。

Aortic valve replacement in elderly patients: Surgical risk and outcome

Objective The aim of this study was to evaluate operative risk factors,early and long-term results of isolated aortic valve and aortic valve replacement combined with other procedures in patients above 75 years old. Methods A retrospective review was performed over the clinical data of 61 patients who underwent isolated aortic valve replacement (group I, n=33) or aortic valve replacement combination with other procedures ［coronary artery bypass graft (CABG), mitral valve repair, et al.］ (group C, n=28), including 44 males and 17 females, aged from 75 to 84 years ［(77.5±2.1) years］. The preoperative cardiac functions of 11 cases were graded as NYHA class Ⅱ, and 50 cases NYHA class Ⅲ or Ⅳ. Results The overall in-hospital mortality was 6.6% (4/61), postoperative low cardiac output being an independent risk factor for in-hospital mortality. The main postoperative complications rate was 45.9%. Group C had longer cardiopulmonary bypass time and aortic cross-clamping time than group I, and used more plasma after operation. No significant difference was found between the two groups in terms of in-hospital mortality, postoperative complication incidence, ICU stays, postoperative hospital stays or long-term surviving state after surgery, etc. Fifty-three out of 57 (92.9%) patients were followed up after discharge with a period of 2-105 months ［(34±28) months］, the overall 1-, 3-, 5-, and 8-year survival rates were 93.9%, 88.7%, 69.4%, 41.6%, respectively. The 1-, 3-, 5-, and 8-year survival rates were 100%, 87.5%, 52.5%, 52.5% and 89.2%, 80.3%, 80.3%, 40.2% in group C and group I, respectively (P=0.796). Conclusions Patients aged 75 and above who underwent aortic valve replacement have acceptable short and long-term outcome despite of a high surgical risk and a high incidence of postoperative complications. Concomitant CABG and other procedures do not significantly increase the risk of surgery or affect the long-term outcome.