大動脈弁の手術を受けた非常に高齢者の長期的な生存率
Donald S Likosky1, Meredith J Sorensen, Lawrence J Dacey
1Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH, USA. donald.likosky@dartmouth.edu
Circulation
|September 16, 2009
まとめ
冠動脈弁置換 (AVR) と冠動脈バイパス移植 (CABG) の手術によるAVR後の生存率は,八十代の患者にとって有利である. 80歳以上の患者の半数以上が6年以上生存し,CABGは生存に悪影響を及ぼさない.
科学分野:
- 心臓病学 心臓病学
- 高齢者の外科手術について
- アウトカム 研究成果 研究成果
背景:
- 高齢者の多くが,大動脈弁の手術を受けています.
- この研究は,この特定の患者集団における短期および長期の生存率に焦点を当てています.
研究 の 目的:
- 大動脈弁手術を受ける非常に高齢の患者の生存率を評価するために.
- 80歳以上の患者で,隔離性大動脈弁置換 (AVR) と,併発性冠動脈バイパス移植 (CABG) の併発性冠動脈弁置換 (AVR) の間のアウトカムを比較する.
主な方法:
- 一つのコホート研究では,1987年から2006年の間に開いた大動脈弁手術を受けた7584人の患者が参加しました.
- 患者の記録は分析され,生存者データのために社会保障局の死亡マスターファイルとリンクされました.
- 生存率は,年齢層 (<80,80-84,>=85歳) と処置タイプ (AVR vs. AVR + CABG) によって層分化されました.
主要な成果:
- フォローアップの39,835人年において,2877人の死亡が発生しました.
- 孤立したAVRの生存期間の中央値は11.5年 (<80年),6.8年 (80-84年),6.2年 (>=85年) でした.
- AVR + CABGの生存期間の中央値は9.4年 (<80年),6.8年 (80-84年),7.1年 (>=85年) であり,生存期間には年齢が著しく影響した (P<0.001).
結論:
- 大動脈弁の手術を受けた80代人の生存率は好調で,半数以上が6年以上生存しています.
- 併用CABG手術は,80歳以上の患者の生存期間の中央値を低下させるようには見えません.
- この研究結果は,高齢の年齢だけでは,これらの処置に対する禁忌ではないことを示唆しています.
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