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首页> 美国卫生研究院文献>Annals of Surgery >Clinical hemodynamic and operative descriptors affecting outcome of aortic valve replacement in elderly versus young patients.
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Clinical hemodynamic and operative descriptors affecting outcome of aortic valve replacement in elderly versus young patients.

机译：影响老年和年轻患者主动脉瓣置换结果的临床血液动力学和手术指标。

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One hundred and fifty-two patients age 70 years or more underwent aortic valve replacement (AVR) at Emory University Hospital between July 1, 1974 and July 1, 1982. Of these, 98 had isolated AVR (elderly AVR group) and 54 had concomitant coronary artery bypass grafts (elderly AVR/CABG group). Results of surgery in these patients were compared to results in patients aged 20 to 69 years operated on in the same period (young AVR/CABG groups). Comparative descriptors with statistically significant differences included a higher incidence of both stable and unstable angina in patients undergoing concomitant CABGs ; less cardiomegaly in the young AVR/CABG group; less hypertension, a higher incidence of pure aortic regurgitation, and less frequent use of inotropes in the young AVR group; a higher perioperative stroke rate in elderly AVR/CABG patients; a higher perioperative psychosis rate in patients having CABGs regardless of age; and a longer postoperative hospital stay for the elderly patients. There were no significant differences between the four groups for the following descriptors: sex ratio; history of congestive heart failure; the presence of atrial fibrillation; left ventricular end diastolic pressure, ejection fraction and contractility; number of diseased coronary arteries; number of vessels bypassed; use of the intra-aortic balloon pump; re-exploration for hemorrhage; perioperative myocardial infarction rate; and major wound infection rate. Operative mortality was 5.1% for the elderly AVR group, 5.6% for the elderly AVR/CABG group, 1.9% for the young AVR group, and 5.1% for the young AVR/CABG group (p = NS). Overall, hospital mortality was 3.3%. Actuarial survival curves for all elderly versus all young patients showed no significant difference. The curve for elderly patients compares favorably with the actuarial survival of the same age group in the general population. Actuarial survival curves for the four subgroups did not differ significantly when compared at a follow-up of 36 months after surgery. We conclude that AVR with or without concomitant CABGs can be performed in elderly patients with an acceptably low mortality and morbidity, and the postoperative survival compared favorably both with younger patients and with the general population of the same age.
机译：在1974年7月1日至1982年7月1日期间，对一百二十五岁70岁或以上的患者进行了主动脉瓣置换术（AVR）。其中，有98例孤立了AVR（老年人AVR组），其中54例伴随了冠状动脉搭桥术（老年人AVR / CABG组）。将这些患者的手术结果与同期接受手术的20至69岁患者（年轻的AVR / CABG组）的结果进行比较。具有统计显着性差异的比较描述词包括伴随CABGs患者稳定型和不稳定型心绞痛的发生率较高;年轻的AVR / CABG组的心脏肥大较少;在年轻的AVR组中，高血压较少，纯主动脉瓣关闭不全发生率较高，且正性肌力药物使用频率较低；老年AVR / CABG患者围手术期卒中率更高;无论年龄大小，患有CABG的患者围手术期精神病发生率更高；老年患者术后住院时间更长。下列描述语在四组之间没有显着差异：性别比；充血性心力衰竭的病史；心房颤动的存在；左心室舒张末期压力，射血分数和收缩力；患冠状动脉的数量；绕行的船只数量；使用主动脉内气囊泵；重新探查出血；围手术期心肌梗塞率；和主要伤口感染率。老年AVR组的手术死亡率为5.1％，老年AVR / CABG组为5.6％，年轻AVR组为1.9％，年轻AVR / CABG组为5.1％（p = NS）。总体而言，医院死亡率为3.3％。所有老年患者与所有年轻患者的精算生存曲线均无显着差异。老年患者的曲线与普通人群中相同年龄组的精算生存率相比具有优势。与术后36个月的随访相比，这四个亚组的精算生存曲线没有显着差异。我们得出的结论是，可以在死亡率和发病率均可接受的老年患者中进行伴有或不伴有CABG的AVR，并且与年轻患者和同年龄段的普通人群相比，其术后生存期均有利。

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