高齢者における大動脈弁置換:遅い結果を決定する要因
Elena A Ashikhmina1, Hartzell V Schaff, Joseph A Dearani
1Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Circulation
|August 10, 2011
まとめ
高齢者の患者における大動脈弁置換術後の長期生存率は,特に併発性疾患を有する患者では,予想より低い. しかし,最もリスクの低いグループは,一般の人々と同様の生存率を示し,バルブタイプは結果に大きく影響しませんでした.
科学分野:
- 心臓病学 心臓病学
- ゲリアトリック・メディシン (老年医学)
- 外科手術の結果について
背景:
- 大動脈弁置換 (AVR) を受けている高齢者の長期的な予後に関するデータは限られている.
- この研究は,AVR後の70歳以上の患者の最新のフォローアップデータを評価することに焦点を当てています.
研究 の 目的:
- 大動脈弁置換術後の高齢患者の長期生存率を評価する.
- この人口集団における遅い死亡率の予測要因を特定する.
- リスクの階層化と義肢のタイプに基づいて生存率を比較する.
主な方法:
- 1993年から2007年の間にAVRを受けた70歳以上の2890人の患者の遡及的分析.
- 術前および術内変数による生存データの階層化.
- 機械的義肢と生物学的義肢を比較する傾向マッチ分析.
- 構造バイオプロテシスの劣化の評価.
主要な成果:
- 観察された5年,10年,15年の生存率は,それぞれ68%,34%,8%で,予想より低かった.
- 遅い死の独立予測要因には,高齢化,腎不全,糖尿病,脳卒中,心筋梗塞,NYHAクラスIII/IVが含まれていました.
- 生存率は,最もリスクが低いグループでは予想値に似ていたが,最もリスクが高いグループでは著しく低かった.
- 機械的義肢と生物学的義肢の間では,生存率の有意な差は見つかりませんでした.
- バイオプロテシスの構造的悪化は稀であった (2.4%).
結論:
- AVR後の患者の生存率は,年齢と術前の併発性疾患によって著しく影響を受けます.
- 最低リスクの高齢患者 (33%) は,一般患者と比較できる生存期間を経験しました.
- 義肢のタイプは長期的な生存に影響を与えないようで,構造的生体義肢の失敗は稀であった.
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