摘要
尽管有清楚的指示，有征兆的严重的心阀门疾病的老病人的 BackgroundA 可观的比例为外科的干预保存地被对待。然而，很少先进年龄和 comorbidities 怎么影响治疗决策和治疗学的 outcomes.MethodsPatients 被知道(n = 234，吝啬的年龄：78.5 ±；3.7 年) 与征兆的严重的心阀门，在我们的中心就医的疾病被包括。151 个病人(65%) 通过手术被对待(外科的组) 并且(35%) 83 保存地被对待(保守的组) 。影响了治疗学的决策和治疗结果的因素被调查，长期的幸存是 explored.ResultsIsolated 大动脉的阀门疾病，女性别，长期的肾的不足，年老的 ≥；80 年，肺病，和突现的地位是与治疗学的决策联系的独立因素。为外科的组的在里面医院死亡是 5.3%(8/151 ) 。在保守的组的三个病人(3.6%) 在起始的住院期间死了。低心脏的产量症候群和长期的肾的不足在外科的组作为在里面医院死亡的预言者被识别。保守治疗在全部学习人口为迟了的死亡作为单个风险因素被识别。外科的组最好 5 年(77.2% 对 45.4% ， P <；0.0001 ) 并且 10 年(34.5% 对 8.9% ， P <；0.0001 ) 幸存比保守的组评价，甚至当由倾向调整了时，匹配分数的 analysis.ConclusionsAdvanced 年龄和衰老老人 comorbidities 深刻地为严重的心阀门疾病影响治疗决策。阀门外科在老是安全的，但是当保守治疗为有征兆的严重阀门疾病的病人是相反的时，也与好长期的幸存被联系不仅。
Background A considerable proportion of elderly patients with symptomatic severe heart valve disease are treated conservatively de- spite clear indications for surgical intervention. However, little is known about how advanced age and comorbidities affect treatment deci-sion-making and therapeutic outcomes. Methods Patients （n = 234, mean age： 78.5 ± 3.7 years） with symptomatic severe heart valve dis- ease hospitalized in our center were included. One hundred and fifty-one patients （65%） were treated surgically （surgical group） and 83 （35%） were treated conservatively （conservative group）. Factors that affected therapeutic decision-making and treatment outcomes were investi- gated and long-term survival was explored. Results Isolated aortic valve disease, female sex, chronic renal insufficiency, aged _〉 80 years, pneumonia, and emergent status were independent factors associated with therapeutic decision-making. In-hospital mortality for the surgical group was 5.3% （8/151）. Three patients （3.6%） in the conservative group died during initial hospitalization. Low cardiac output syndrome and chronic renal insufficiency were identified as predictors of in-hospital mortality in the surgical group. Conservative treatment was identi- fied as the single risk factor for late death in the entire study population. The surgical group had better 5-year （77.2% vs. 45.4%, P 〈 0.0001） and 10-year （34.5% vs. 8.9%, P 〈 0.0001） survival rates than the conservative group, even when adjusted by propensity score-matched analysis. Conclusions Advanced age and geriatric comorbidities profoundly affect treatment decision-making for severe heart valve disease. Valve surgery in the elderly was not only safe but was also associated with good long-term survival while conservative treatment was unfavorable for patients with symptomatic severe valve disease.
