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美国老年患者的大动脉置换的趋势,1999-2011年

José Augusto Barreto-Filho¹, Yun Wang, John A Dodson

¹Division of Cardiology, Federal University of Sergipe, and the Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil10Center for Outcomes Research and Evaluation at Yale-New Haven Hospital (during the time that the work was conducted).

|November 19, 2013

Importance:

随着人口老龄化以及经导管治疗方案的出现，有必要描述当前主动脉瓣置换术（AVR）的临床结果。

目的:

评估随时间推移外科主动脉瓣置换术的手术率及治疗结果。

设计、环境与参与者:

一项针对1999年至2011年间在美国接受主动脉瓣置换术（AVR）的82,755,924名联邦医疗保险按服务收费受益者的连续横断面队列研究。

主要结局与测量指标:

单纯外科主动脉瓣置换术（AVR）及联合冠状动脉旁路移植术（CABG）的手术率、30天和1年死亡率，以及30天再入院率。

结果:

在12年期间，每10万人-年主动脉瓣置换术（AVR）的手术率增加了19例（95% CI，19–20），经年龄、性别和种族调整后，年增长率为1.6%（95% CI，1.0%–1.8%）（P<0.001）。术后30天死亡率逐年下降（绝对下降3.4%；95% CI，3.0%–3.8%；调整后年下降率4.1%；95% CI，3.7%–4.4%），1年死亡率也逐年下降（绝对下降2.6%；95% CI，2.1%–3.2%；调整后年下降率2.5%；95% CI，2.3%–2.8%）。30天全因再入院率每年下降1.1%（95% CI，0.9%–1.3%）。接受AVR联合冠状动脉旁路移植术（CABG）的患者比例下降；女性和黑人患者的手术率较低，但死亡率较高；机械瓣假体植入比例减少，但在2011年仍有23.9%的85岁及以上患者接受了机械瓣假体植入。

结论与相关性:

1999年至2011年间，美国老年患者接受外科主动脉瓣置换术（AVR）的比例上升，且手术预后显著改善。由于医疗保险（Medicare）数据无法确定研究结果的成因，手术率及预后变化趋势之间无法建立因果关系。然而，该研究结果可为适合手术且正在考虑接受新型经导管治疗的老年患者提供外科AVR预后的有用基准。

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