Clinical Study On The Results Of Surgical Revascularization In Patients With Coronary Heart Disease Over 75 Years Old And The Surgical Treatment Strategy Of Ventricular Septal Perforation After Myocardial Infarctio

Background The amount of elderly and very elderly patients with coronary artery(CAD)disease is increasing rapidly.However,the optimal revascularization strategy in this population is the subject of ongoing debate,and current consensus guidelines do not state specific treatment recommendations.This study aims to assess the prognosis and identify the risk factors of surgical revascularization in CAD patients over 75-year old age.Methods This retrospective cohort study included aged over 75 year-old patients with a diagnosis of CAD,from the database contained in the Fuwai Hospital of Chinese Academy of Medical Sciences during 2012 to 2020.Propensity score matching was used to adjust for baseline differences between the two groups,and Logistic regression model and Cox regression model were used to find the risk factors of postoperative and longterm death.Results The mean age of cohort was 77.0±2.2 years,and the postoperative 30-day mortality was 1.13%.The 30-day mortality were 0.61%and 1.20%in the≥80 years old group and the<80 years old group,respectively,without significant difference.However,the ratio of postoperative delayed recovery was significantly higher in the≥80 years old group than in the<80 years old group.Logistic regression model identified that healed myocardial infarction and preoperative instability were the independent risk factors for the 30-day mortality in the cohort.Propensity score matching yielded 163 pairs of patients in which there were no significant differences in baseline characteristics and the 30-day mortality between the two groups.The mean survival time was 56.3 months;the 5-year survival rate was 91.0%;and the 10-year survival rate was 48.1%.Log-Rank analysis showed that there was no significant difference in the incidence of major cardiovascular and cerebrovascular adverse events(MACCE),death caused by MACCE and all-cause death between the two groups.Multivariable Cox regression analysis confirmed healed myocardial infarction as an independent risk factor for the incidence of MACCE and Death caused by MACCE.Conclusion Patients with advanced age suffering from complex coronary artery disease present a acceptable prognosis after surgical revascularization.Although patients aged over 80 years were more likely prone to delayed postoperative recovery than patients aged 75～79 years,they had comparable postoperative and middle-term mortality risks.For the patients aged over 75 years,healed myocardial infarction and preoperative instability were the independent risk factors for the 30-day mortality.Healed myocardial infarction is an independent risk factor for middle-term MACCE and Death caused by MACCE.Background Postinfarction ventricular septal rupture is an uncommon but challenging mechanical complication for surgeons.The aim of the study was to identify risk factors of postoperative mortality after surgical repair of postinfarction ventricular septal rupture(VSR),and obtain the best timing of surgery.Methods During a 15-year period,from Jan 2006 to Dec 2020,112 patients underwent repair of postinfarction ventricular septal rupture.Data were collected on clinical,angiographic,and echocardiographic findings;operative procedures;early morbidity and mortality;and survival time.Univariable and multivariable analyses were performed to identify predictors of 30-day mortality.ROC curve was used to identify the cut-off point.Patients were grouped according to the cut-off point for best surgery timing,and were also grouped according to the location of myocardial infarction(MI)to analyze the influence on the outcomes of operations.Results Thirty-day mortality was 7.14%for the whole cohort.The mean survival time estimate was(147.25±5.94)months,with a 3-year survival rate of 91.20%and a 5year survival rate of 87.80%.Compared with the survival group(n=104),the death group(n=8)tend to have older ages,more females,and the shorter interval between myocardial infarction onset and operation.The 30-day mortality of anterior wall group(n=86)was higher than the inferior and posterior wall group(n=26)(P>0.05),but with no statistical significant difference.Multivariable analysis regarded shorter infarctionsurgery intervals,elder ages,female gender,and previous cerebrovascular accidents as predictors of 30-day mortality.The ROC curve indicated that the best infarction-surgery interval was 37.04 days.Compared with patients with an infarction-surgery interval>37 days,patients with an interval of ≤37 days had a higher 30 days mortality(20.69%vs.3.45%,P=0.044)and a shorter mean survival time at mid-term follow-up[(120.53± 14.10)months vs.(156.56±4.69)months,Log rank P=0.001].However,no statistically significant differences in survival were observed between the two groups after propensity score matching[(124.96±13.91)months vs.(138.59±13.01)months,Log rank P=0.331]by the Kaplan-Meier survival curve.Conclusion The priority choice for VSR patients who respond well to aggressive treatment should be delayed surgery.The best timing of delayed surgery is until the 37th day after infarction.Background Postinfarction ventricular septal rupture is an uncommon but challenging mechanical complication for surgeons.This study analyzed the impacts of rupture size on surgical outcomes in patients with VSR.Methods During a 15-year period,from January 2006 to December 2020,112 patients underwent repairs of postinfarction VSR in our center.Patient clinical data,including angiographic and echocardiographic findings,operative procedures,early morbidity and mortality,and survival time were collated.Cases were grouped based on the cut-off point calculated by the ROC curve and Youden index.Univariable and multivariable Logistic regressions were performed to identify the risk factors of 30-day mortality.Results The 30-day mortality rate was 7.1%for the whole cohort.The receiver operating characteristic(ROC)curve indicated that the rupture enlargement rate could predicted the 30-day mortality with high accuracy.Multivariable analysis revealed that rupture enlargement rate is an independent risk factor of 30-day mortality.The median survival time estimates for the low ΔDR group and the high ΔDR group were 154.9 months and 1 13.8 months,respectively,with statistically significant differences.Conclusions The rupture enlargement rate is an independent risk factor for postoperative 30-day mortality in patients with delayed VSR repair,which has also good predictive value for the prognosis of VSR patients.