70岁以上中重度主动脉瓣狭窄患者手术高危因素分析

Clinical outcomes of aortic valve replacement in septuagenarians with moderately severe aortic stenosis

目的:70岁以上老年中重度主动脉瓣狭窄(AS)患者行主动脉瓣置换术(AVR)早期疗效分析。方法:回顾性分析我院2013年1月至2015年8月,心脏外科108例70岁以上中重度AS患者进行AVR的临床资料。结果:108例老年患者,男性82例,女性26例,平均年龄(78.6±5.2)岁,住院30d死亡6例(5.6%)。Logistic回归分析显示,住院30d死亡危险因素与术前肾功能不全、术前心功能NYHAⅣ级、体外循环时间≥180min、同时合并冠状动脉移植手术有关。随访26.3个月,随访率97.2%,死亡2例,1例发生脑部并发症,1例死于非心源性猝死。所有患者术后心功能和生活质量较术前明显提高。结论:术前脏器功能不全是患者住院死亡的主要危险因素,提示早期手术的重要性。

Objective： To investigate early clinical outcomes in patients of 70 years and older with moderately severe aortic stenosis （AS） undergoing aortic valve replacement （AVR）. Methods： Clinical data of 108 consecutive septuagenarians who underwent AVR between January 2013 and August 2015 were retrospec- tively analyzed. Result： There were 108 patients of moderately severe aortic stenosis with aortic valve replacement. Operative mortality of septuagenarians was 5.56%, the Logistic regression analysis revealed that postop- eration renal failure, NYHA class IV, CPB time and concomitant procedure of coronary artery bypass graft were the related risk factors of operative mortality in septuagenarians. The mean follow-up duration of septuagenarians were 26. 3 months, 3 cases were lost in the follow-up. One death was brain complication and other was sudden death. Heart function improved significantly after operation of survival septuagenarians. Conclusion： The main organs dysfunction is a powerful predictor of outcome in patients with moderately severe aortic stenosis undergoing aortic valve replacement in septuagenarians. These results stress the importance of early operation.