中国合并心力衰竭的老年心脏瓣膜病患者的临床特征与外科治疗现状

Clinical Characteristics and Surgical Treatment Status of Aged Patients With Valvular Heart Disease and Heart Failure in China

目的:分析中国合并心力衰竭的老年心脏瓣膜病患者的临床特征及外科治疗现状。方法:依托中国急慢性心力衰竭外科注册登记(China-HFSR)研究,收集2012年1月至2020年12月期间中国北部、东部、中部、南部、东北部、西南部、西北部7个地区接受心脏瓣膜手术且合并心力衰竭的老年(≥65岁)心脏瓣膜病患者的人口统计学信息、临床特征和治疗情况。以院内死亡作为结局判断指标。通过广义线性模型计算各地区风险因素标化院内死亡率(RSMR)。结果:自2012年1月至2020年12月,全国心血管外科年手术量超过100例的109家心脏中心共完成合并心力衰竭的老年心脏瓣膜病外科手术患者2521例,其中东部、北部、中部、西南部、西北部、东北部、南部7个地区分别为927例(36.8%)、554例(22.0%)、300例(11.9%)、300例(11.9%)、178例(7.1%)、156例(6.2%)、106例(4.2%)。患者的中位年龄为68.7(66.7,72.2)岁,34.7%为女性。风湿性心脏瓣膜病占37.2%,退行性心脏瓣膜病占34.2%。主动脉瓣置换术1597例(63.3%),二尖瓣手术1506例(59.7%),主动脉瓣置换术联合二尖瓣手术609例(24.1%)。823例(32.6%)患者同期接受冠状动脉旁路移植术。院内总死亡率为7.0%。西南部地区院内死亡率最低,为2.33%,西北部地区最高,为10.11%。西南部地区RSMR最低,为3.34%,北部地区RSMR稍高,为5.40%,西北地区RSMR最高(10.95%)。结论:在中国,合并心力衰竭的老年心脏瓣膜病外科手术患者中,风湿性病变仍是最常见的病因,退行性病变所占比例增加。外科治疗数量较少且院内死亡率地区间差异显著。

Objectives:To analyze the clinical characteristics and surgical treatment status of aged patients with valvular heart disease(VHD)and heart failure in China.Methods:Data were collected from the China Heart Failure Surgery Registry(China-HFSR)study database.The demographic information,clinical characteristics and treatment patterns of aged(≥65 years old)patients with heart failure who underwent valve surgery in 7 different regions in China(northeast,north,east,central,south,southwest,and northwest)from January 2012 to December 2020 were analyzed.In-hospital mortality was regarded as the primary endpoint.Using hierarchical generalized linear models,we estimated region-level risk standardized in-hospital mortality rates(RSMR).Results:From January 2012 to December 2020,data on 2521 aged patients with VHD and heart failure from the 7 regions were registered from 109 participating centers with the adult cardiac surgery volume of more than 100 operations per year.Among the cases,rheumatic heart disease(RHD)accounted for 37.2%,and degenerative VHD accounted for 34.2%.The number of aortic valve surgeries was 1597(63.3%),which was slightly higher than that of mitral valve surgeries(n=1506,59.7%).The number of concurrent aortic and mitral valve surgeries was 609(24.1%).A total of 823 surgical VHD patients(32.6%)also underwent coronary artery bypass grafting(CABG).The overall observed in-hospital mortality rate was 7.0%.The lowest and highest observed in-hospital mortality rates were in the southwest region(2.33%)and the northwest region(10.11%),respectively.The lowest RSMR(3.34%)was in the southwest region,followed by 5.40%in the north region and the highest RSMR(10.95%)was in the northwest region.Conclusions:In aged patients with heart failure who underwent valve surgery in China,RHD was still the major cause of the VHD,with a significant increase in degenerative valve disease.The number of valve surgery in this specific population was small and there was marked regional variation in the in-hospital mortality post valve surgery.