80岁以上患者冠状动脉旁路移植术早中期结果分析

Early and midterm outcomes of coronary artery bypass grafting in octogenarians

目的 回顾性分析80岁以上老年患者行冠状动脉旁路移植术的近远期疗效及其危险因素.方法 2001年9月至2010年11月,38例80岁及以上高龄患者行单纯冠状动脉旁路移植术.本组患者男性33例,女性5例；年龄80～87岁,平均（82.6±1.2）岁.其中常规心肺转流冠状动脉旁路移植术12例,非体外循环冠状动脉旁路移植术26例.平均移植血管（2.5±1.1）支.胸廓内动脉使用率97.3％.结果 围手术期死亡1例,病死率2.6％；术后新发脑梗死4例,发生率10.5％.脑梗死、肺部并发症等总体并发症发生率为15.8％（6/38）.术后早期心房颤动25例,占65.8％.平均ICU停留时间为（3.841.4）d,平均术后住院时间为（15±6）d.38例患者均获得随访,随访4～70个月,术后5年内死亡6例,5年生存率84.2％,92.1％的患者术后无心脏相关事件发生.结论 对80岁以上患者实施冠状动脉旁路移植术可以获得肯定的近中期疗效,但需选择合适的手术策略并具有精细的围手术期处理经验.

Objective To investigate the early and midterm postoperative outcomes and analyze risk factors of coronary artery bypass grafting（CABG）in octogenarians.Methods Clinical data of 38 patients aged 80 years or greater receiving isolated coronary artery bypass grafting from September 2001 to November 2010 were reviewed.There were 33 male and 5 female patients,aging from 80 to 87 years with a mean of （82.6 ± 1.2）years.Twelve patients underwent conventional（on-pump）CABG and 26 patients underwent off-pump CABG.The number of bypass grafts was 1 to 5（mean 2.5 ± 1.1）.Left internal mammary artery was used in 37（97.3%）patients.Results The perioperative mortality was 2.6%（1/38）.Postoperative complications included stroke（4 cases）,respiratory infection（1 case）.The atrial arrhythmias occurred in 25 patients.Intensive care unit and hospital length of stay lasted（3.8 ± 1.4）days and（15 ± 6）days,respectively.Totally 38 patients were followed up for 4 to 70 months.Six patients died during the follow-up period.The 92.6% patients recovered without any cardiac events.Conclusions Isolated CABG can be performed safely with acceptable postoperative morbidity and mortality in octogenarians.Appropriate surgical strategy and intensive perioperative treatment must be enhanced in octogenarians who underwent CABG.