高龄患者主动脉瓣置换的手术风险及疗效分析

Aortic valve replacement in elderly patients:Surgical risk and outcome

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。

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 g%oups in terms of in-hospital mortality, postoperative complication incidence, ICU stays, postoperative hospital stays or long-term surviving state aftersurgery, 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.