一个bstract
CTEPH patients over 80 years old undergoing pulmonary endarterectomy have similar outcomes to those under 80 yearshttp://ow.ly/MlCj30guFPu
致编辑:
肺部内膜切除术(PEA)是可操作的慢性血栓栓塞性肺动脉高压(CTEPH)的选择,具有出色的长期结局[1]。我t is a complex surgical procedure requiring cardiopulmonary bypass and removal of obstructive thromboembolic material during periods of deep hypothermic circulatory arrest [1]。We have observed an increase in the number of older CTEPH patients referred for consideration of PEA, which is consistent with other cardiothoracic surgeries. The UK population is ageing with a projected 3% increase in subjects aged >85 years in the next 20 years [2]。CTEPH患者可能会反映这可能会反映出年龄,因为肺栓塞的发生率经常在CTEPH之前显着增加,随着年龄的增长[3,,,,4]。此外,G的流行病学分析全部等。[[5] has projected that the annual incidence of CTEPH will increase over the next 10 years. Therefore, the management of CTEPH in older patients is a pertinent topic for investigation.
We previously reported that hospital survival in patients over 70 years undergoing PEA was similar to those under 70 years, albeit with longer hospital and intensive care unit (ICU) stays [6]。对于选定的心脏手术(冠状动脉搭桥术和主动脉瓣手术),八十岁的人比年龄和性别匹配的人群具有等效或改善的长期死亡率[7,,,,8]。Furthermore, patient reported outcomes (PROs) including quality of life improve postoperatively, and are equivalent or better than a matched general population of octogenarians [7,,,,9]。However, increased in-hospital mortality and prolonged hospital/ICU length of stay have also been reported, which may translate to increased health utilisation costs [10,,,,11]。因此,在当前的研究中,我们旨在评估接受PEA的80岁以上的CTEPH患者的结果。
从2006年6月至2016年8月在英国国家豌豆中心(英国Papworth)进行PEA的连续CTEPH患者被包括在回顾性分析中。CTEPH的诊断是基于国际标准[12]。suitability for PEA was discussed by a multidisciplinary team, comprising pulmonary hypertension physicians, specialist cardiothoracic radiologists and pulmonary endarterectomy surgeons. The cohort was dichotomised into those over and under 80 years according to age at the time of surgery. Preoperative baseline and postoperative 3–6-month follow-up data were recorded, with follow-up data included until 3 months after the end of the census period. PROs were assessed using the Cambridge Pulmonary Hypertension Outcome Review (CAMPHOR) score, a PH-specific quality of life measure [13]。使用卡方检验进行分类数据,Wilcoxon秩和测试的连续数据和对数秩检验的生存数据进行比较。错误的发现率调整后的P值用于说明多次测试。
一个total of 1152 individuals underwent PEA (under 80 years, 1115 (97%); over 80, 37 (3%)) during the study period. Baseline and 3–6-month follow-up variables and outcomes are summarised intable 1。Overall survival at 1, 3 and 5 years was 91.8%, 88.2% and 84.4% in the under 80 group, and 83.5%, 76.4% and 69.4% in the over 80 group. Although survival was lower in the over 80 group (log-rank test; p=0.020), it was no different from an age- and sex-matched UK reference population (p=0.500) [15]。
There were significant improvements in World Health Organization (WHO) functional class, 6-minute walk distance (6MWD) and haemodynamics for both the under and the over 80s post-PEA. Although the 6MWD was lower in the over 80s post-PEA (286±164相对360±92; p=0.020) there was an equivalent change from baseline (p=0.676) reflecting the same magnitude of improvement. Furthermore, there was no difference in the median change from baseline for WHO functional class, haemodynamics or PROs between the under and the over 80s, indicating an equivalent improvement in outcomes.
有更多concomitant cardiac surgical procedures in the over 80 group (11%相对27%;p = 0.042),主要是由于更多的冠状动脉搭桥移植物(7%)相对19%)。心肺旁路时间较短(323±305分钟相对305±65;p = 0.020)在80年代以上,但总深度低温循环停止时间或手术疾病类型(基于位置和形态的杰米森分类)没有差异(p = 0.230和p = 1.000)。在80岁以上的住院时间更长(19±7相对14±10天;p = 0.020),但在ICU上花费的时间没有差异(4±3相对5±5 days; p=0.310). There was also no difference in post-PEA complications (p=1.000) or in hospital mortality (4%相对8%; p=0.510).
despite the study limitations (small group size of over 80s, retrospective single-centre analysis), we found similar outcomes in patients under and over 80 years old undergoing PEA, except for a prolonged hospital length of stay in octogenarians. Although survival is reduced in the over 80 group compared with the under 80s, it is no different to a reference age- and sex-matched UK population. The greater number of concomitant cardiac surgeries in octogenarians could indicate that their improvement is multifactorial. Future research should consider the health utilisation and cost implications of older patients undergoing PEA, given they have a prolonged hospital length of stay.
We acknowledge that CTEPH patients over 80 years were highly selected to undergo PEA and therefore our results may not apply to ‘all comers’. However, it reinforces the effectiveness of the PEA selection process at expert centres. Age alone should not be a contraindication for PEA, and individuals with suspected CTEPH should be referred for specialist evaluation.
disclosures
supplementary Material
J. CannonERJ-01804-2017_CANNON
d。詹金斯erj - 01804 - 2017_Jenkins
m。纽纳姆erj - 01804 - 2017_Newnham
J. Pepke-ZabaERJ-01804-2017_PEPKE-ZABA
K. Sheareserj - 01804 - 2017_Sheares
一个cknowledgements
作者希望感谢英国和爱尔兰国家肺动脉高压中心的参考。
Footnotes
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- 已收到2017年9月2日。
- 公认2017年9月16日。
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