接受房间隔缺损封堵术的老年患者的长期预后：我们的行动是否太晚了？

IF 3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2024-11-18 DOI:10.1016/j.cpcardiol.2024.102930

Maria Rita Lima , Mariana Sousa Paiva , Sérgio Maltês , Sérgio Madeira , Inês Carmo Mendes , José Pedro Neves , Rui Anjos

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引用次数: 0

摘要

背景：房间隔缺损（ASD）通常在晚期才被发现。关闭 ASD 对老年患者预期寿命的影响仍不清楚。本研究比较了年龄≥65 岁、接受了 ASD 关闭术的患者的生存率和平均预期寿命 (ALE)：方法：单中心回顾性研究，包括1998-2020年间所有年龄≥65岁、接受过ostium secundum (OS) ASD闭合术（手术/经皮）的患者。对每位患者的基线特征和术前ALE预测值（根据预先定义的国家ALE表确定）进行了评估：706名患者接受了OS ASD闭合术，其中37人（5%）的年龄≥65岁，平均年龄为69±5岁，62%的患者患有心力衰竭。平均 ASD 大小=21±9mm，22% 的患者有严重的三尖瓣返流，平均肺动脉收缩压（SPAP）=50±11mmHg。五名患者接受了手术治疗。平均随访时间为 9±5 年，死亡率为 46%，发生在术后 8.8±5.3 年。25名患者（68%）的预期ALE寿命超过了预期寿命。总体而言，患者的平均死亡年龄与预测的ALE没有差异（79±6岁 vs. 84±1岁，P=0.304），但早逝患者与超过ALE的患者之间存在10年的绝对差异（77±4岁 vs. 87±3岁，P结论：晚期ASD关闭术后的存活率与预期的ALE相当，但有三分之一的患者过早死亡。较高的 SPAP 和严重的三尖瓣反流与过早死亡有关。对老年人进行 ASD 关闭术需要进行全面评估，以确保获得最大益处。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Long-term prognosis of elderly patients undergoing atrial septal defect closure: Are we acting too late?

查看原文本刊更多论文

Long-term prognosis of elderly patients undergoing atrial septal defect closure: Are we acting too late?

Background

Atrial septal defects (ASD) often go unrecognized until very late in life. The impact of ASD closure on life expectancy in elderly patients remains unclear. This study compares the survival of patients≥65-years who underwent ASD closure with their average life expectancy (ALE).

Methods

Single-centre retrospective study including all patients ≥65-years who underwent ostium secundum (OS) ASD closure (surgical/percutaneous) between 1998-2020. Baseline characteristics and the predicted peri-procedural ALE (as determined per pre-defined national ALE tables) for every given patient were assessed.

Results

706 patients underwent OS ASD closure, 37 (5%) had ≥65 years–mean age 69±5 years, 62% presented with heart failure. Mean ASD size=21±9mm, 22% patients had severe tricuspid regurgitation, mean systolic pulmonary artery pressure (SPAP)=50±11mmHg. Five patients were treated surgically. At a mean follow-up of 9±5 years, mortality rate was 46%, occurring 8.8±5.3 years after the procedure. 25 (68%) outlived their predicted ALE. Overall, the mean age of death did not differ from the predicted ALE (79±6 vs. 84±1 years, p=0.304), however there was a 10-year absolute difference between patients who died prematurely vs. those who surpassed ALE (77±4 vs. 87±3 years, p<0.001). Patients who failed to reach ALE had higher SPAP (58±10 vs. 46±8mmHg, p=0.001) and a higher incidence of severe tricuspid regurgitation (42 vs. 12%, p=0.040).

Conclusion

Survival after late ASD closure was comparable to the expected ALE, though one-third of the patients died prematurely. Higher SPAP and severe tricuspid regurgitation were associated with premature death. ASD closure in elderly requires a thorough evaluation to ensure maximum benefit.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.