Abstract:
OBJECTIVE:The current study was undertaken to determine long-term results of aortic valve replacement (AVR) in the elderly, to ascertain predictors of poor outcome, and to assess quality of life. SUMMARY BACKGROUND DATA:Aortic valve replacement is the procedure of choice for elderly patients with aortic valve disease. The number of patients aged 70 and older requiring AVR continues to increase. However, controversy exists as to whether surgery devoted to this subset reflect a cost-effective approach to attaining a meaningful quality of life. METHODS:This study reviews data on 247 patients aged 70 to 89 years who underwent isolated AVR between 1980 and 1995; there were 126 men (51%) and 121 women (49%). Follow-up was 97% complete (239/247 patients) for a total of 974.9 patient-years. Mean age was 76.2 +/- 4.8 years. Operative mortality and actuarial survival were determined. Patient age, gender, symptoms, associated diseases, prior conditions, New York Health Association class congestive heart failure, native valve disease, prosthetic valve type, preoperative catheterization data, and early postoperative conditions were analyzed as possible predictors of outcome. Functional recovery was evaluated using the SF-36 quality assessment tool. RESULTS:Operative mortality was 6.1% (15/247). Multivariate logistic regression showed that poor left ventricular function and preoperative pacemaker insertion were independent predictors of early mortality. After surgery, infection was predictive of early mortality. Overall actuarial survival at 1, 5, and 10 years was 89.5 +/- 2% (198 patients at risk), 69.3 +/- 3.4% (89 patients at risk), and 41.2 +/- 6% (13 patients at risk), respectively. Cox proportional hazards model showed that chronic obstructive pulmonary disease and urgency of operation were independent predictors of poor long-term survival. Postoperative renal failure also was predictive of poor outcome. Using the SF-36 quality assessment tool, elderly patients who underwent AVR scored comparably to their age-matched population norms in seven of eight dimensions of overall health. The exception is mental health. CONCLUSIONS:Aortic valve replacement in the elderly can be performed with acceptable mortality. Significant preoperative risk factors for early mortality include poor left ventricular function and preoperative pacemaker insertion. Predictors of late mortality include chronic obstructive pulmonary disease and urgency of operation. These results stress the importance of operating on the elderly with aortic valve disease; both long-term survival and functional recovery are excellent.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Tseng EE,Lee CA,Cameron DE,Stuart RS,Greene PS,Sussman MS,Watkins L,Gardner TJ,Baumgartner WAdoi
10.1097/00000658-199706000-00017subject
Has Abstractpub_date
1997-06-01 00:00:00pages
793-802; discussion 802-4issue
6eissn
0003-4932issn
1528-1140journal_volume
225pub_type
杂志文章abstract:OBJECTIVE:To study graft function and ischemia/reperfusion injury of porcine kidneys after preservation with the new Groningen Machine Perfusion (GMP) system versus static cold storage (CS). INTRODUCTION:The increasing proportion of marginal and nonheart beating donors necessitates better preservation methods to maint...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31815c4019
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:Evaluate the value of cytology relative to imaging features in risk assessment for malignancy as defined in the Sendai Guidelines. BACKGROUND:The Sendai Guidelines list symptoms, cyst size >30 mm, dilated main pancreatic duct (MPD) >6 mm, mural nodule (MN) and "positive" cytology as high risk stigmata for ma...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182383118
更新日期:2011-12-01 00:00:00
abstract::A patient with a syphilitic aneurysm of the aorta treated by the insertion of wire is presented. The patient remained well for almost 40 years, but finally succumbed after rupture. The autopsy findings are discussed. To our knowledge, this represents the longest reported survival after treatment of an aortic aneurysm ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197612000-00014
更新日期:1976-12-01 00:00:00
abstract:OBJECTIVE:This study investigated the current state of fecal and urinary continence in an extensive group of adults after operative correction for high anorectal malformations and how they cope with their incontinence. SUMMARY BACKGROUND DATA:Normal fecal continence is hardly to be expected after correction for high a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199308000-00012
更新日期:1993-08-01 00:00:00
abstract::The management of retroperitoneal hematomas remains confusing to many surgeons because the available literature frequently groups patients with blunt and penetrating etiologies together. Because the underlying injuries and their treatment may differ considerably, the nonoperative or operative approach to the common he...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-199002000-00001
更新日期:1990-02-01 00:00:00
abstract:OBJECTIVES:We aimed to examine the association between total number of resected nodes and survival in patients after esophagectomy with and without nCRT. BACKGROUND:Most studies concerning the potentially positive effect of extended lymphadenectomy on survival have been performed in patients who underwent surgery alon...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0000000000000965
更新日期:2014-11-01 00:00:00
abstract:INTRODUCTION:Initial excitement for Natural Orifice Transluminal Endoscopic Surgery (NOTES) has been partly tempered by the reality that a NOTES procedure without laparoscopic or needleoscopic-assistance has not been performed by most groups. After safely performing laparoscopically-assisted transvaginal cholecystectom...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SLA.0b013e3181a802e2
更新日期:2009-06-01 00:00:00
abstract:OBJECTIVE:Generation and maintenance of pain in chronic pancreatitis (CP) have been shown to be partially attributable to neuroimmune interactions, which involve neuropeptides such as substance P (SP). So far, expression of SP receptors NK-2R, NK-3R, the SP-encoding gene preprotachykinin A (PPT-A), and the SP degradati...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e318070d56e
更新日期:2007-11-01 00:00:00
abstract::Twenty patients with extremity soft tissue tumors were prospectively evaluated with magnetic resonance imaging (MRI) and computed tomography (CT) scans with subsequent anatomic correlation of surgical findings. MRI and CT had a similar percentage of accuracy in assessing tumor relationship with major neurovascular (80...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198704000-00002
更新日期:1987-04-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the role of surgical transgastric necrosectomy (TGN) for walled-off pancreatic necrosis (WON) in selected patients. BACKGROUND:WON is a common consequence of severe pancreatitis and typically occurs 3 to 5 weeks after the onset of acute pancreatitis. When symptomatic, it...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000003048
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:To determine the prognostic influence of residual tumor at or within 1 mm of the mobilization margins (R1Mobilization) compared with transection margins (R1Transection) following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma (PDAC). BACKGROUND:The prognostic strength of R1 status increases wit...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181d77369
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the first 1000 liver transplants performed at UCLA Medical Center to determine factors responsible for improved results. SUMMARY BACKGROUND DATA:Liver transplant has evolved impressively since the first case was performed in 1963. The 1980s have highlighted this progress with the development of b...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199405000-00007
更新日期:1994-05-01 00:00:00
abstract::The efficacy of supplemental fresh frozen plasma (FFP) therapy after massive packed red cell (PRBC) replacement for hemorrhagic shock was studied in 22 conditioned dogs. Ten dogs were randomized to received FFP, balanced electrolyte solution (BES), and PRBC, while 12 dogs received BES and PRBC. Coagulation factor acti...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198510000-00010
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVE:To evaluate the effect of selective intramesenteric artery vasodilator infusion on intestinal viability in a rat model of acute segmental mesenteric vascular occlusion. SUMMARY BACKGROUND DATA:Although intramesenteric arterial vasodilator infusion may be an effective treatment for nonocclusive mesenteric isc...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200107000-00016
更新日期:2001-07-01 00:00:00
abstract::After attaching appropriate monitoring devices enabling the measurement of the slope of the left ventricular function curve, left atrial pressure, mean aortic pressure, peak left ventricular pressure, and tension time index, three groups of ten dogs were subjected to varying periods of hemorrhagic shock until a slope ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197501000-00025
更新日期:1975-01-01 00:00:00
abstract:OBJECTIVE:The authors investigate the recovery of gastrointestinal motility in the fed and fasted state after laparoscopic and open cholecystectomy. SUMMARY BACKGROUND DATA:Clinical recovery after laparoscopic cholecystectomy is known to be more rapid than after conventional open cholecystectomy. However, the actual e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199604000-00010
更新日期:1996-04-01 00:00:00
abstract::This report reviews the experience of the Hepatobiliary Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London with 16 patients having proximal extrahepatic bile duct malignancy who underwent resection and a comparable group of 15 patients who had surgical bypass. The purposes of the review were to eval...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198406000-00001
更新日期:1984-06-01 00:00:00
abstract:OBJECTIVE:A randomized controlled trial to confirm the non-inferiority of laparoscopic surgery to open surgery in terms of overall survival was conducted, and short-term surgical outcomes are demonstrated. BACKGROUND:The efficacy and safety outcome of laparoscopic surgery for clinical stages II/III colon cancer underg...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000000499
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:To report on the long-term follow-up of a randomized clinical trial comparing pancreatic head resection according to Beger and limited pancreatic head excision combined with longitudinal pancreatico-jejunostomy according to Frey for surgical treatment of chronic pancreatitis. SUMMARY BACKGROUND DATA:Resectio...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.sla.0000157268.78543.03
更新日期:2005-04-01 00:00:00
abstract:OBJECTIVE:The HepatAssist liver support system is an extracorporeal porcine hepatocyte-based bioartificial liver (BAL). The safety and efficacy of the BAL were evaluated in a prospective, randomized, controlled, multicenter trial in patients with severe acute liver failure. SUMMARY BACKGROUND DATA:In experimental anim...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.sla.0000124298.74199.e5
更新日期:2004-05-01 00:00:00
abstract::Stress ulcer has become an important clinical entity and its two major complications--bleeding and perforation--are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197912000-00006
更新日期:1979-12-01 00:00:00
abstract:BACKGROUND:The presence and number of nodal metastasis significantly impact colon cancer prognosis. Similarly, the number of resected/evaluated nodes impacts staging accuracy. This ratio of metastatic to examined nodes or lymph node ratio (LNR) may have independent prognostic value in colon carcinoma. PURPOSE:: To eva...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ffa780
更新日期:2011-01-01 00:00:00
abstract::In construction of the eosphagojejunostomy after total gastrectomy, the EEA stapled (US Surgical Corporation, Norwalk, CT) and the two-layer interrupted 3-0 Dexon anastomoses are compared concerning the radiological appearance, breaking strength, circulation, and collagen concentration. Thirty female pigs were used. A...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198604000-00017
更新日期:1986-04-01 00:00:00
abstract:OBJECTIVE:To analyze the long-term results of distal pancreatectomy with en bloc celiac axis resection (DP-CAR), a newly designed extended surgical procedure for locally advanced cancer of the pancreatic body. SUMMARY BACKGROUND DATA:Pancreatic body cancer often involves the common hepatic artery and/or the celiac axi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000258608.52615.5a
更新日期:2007-07-01 00:00:00
abstract::To determine the significance of proteolysis and delayed freezing of tumor samples on estrogen receptor levels, values from 19 of 31 biopsy specimens were compared with that in remaining tumor at the completion of mastectomy. There was a 15-100% decrease in receptor content. Time-decay studies on selected postmastecto...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198105000-00003
更新日期:1981-05-01 00:00:00
abstract::The costs for elective cholecystectomies were measured 1955, 1965 and 1975. The average length of stay decreased by 25% between 1955 and 1965 and with the same amount between 1965 and 1975. In spite of these marked reductions in the average length of stay there was only a significant decrease in costs between 1955 and...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:
更新日期:1979-04-01 00:00:00
abstract:OBJECTIVES:The aim of the study was to evaluate and study the full spectrum of swallowing dysfunction and long-term disease-specific outcomes in adults with surgically corrected esophageal atresia/tracheaesophageal fistula (EA/TEF). BACKGROUND:Long-term outcomes for adults who underwent EA/TEF repair because infants a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001978
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVE:The objective of the study was to determine the long-term effect of the use of a hyaluronic acid-carboxymethylcellulose membrane (Seprafilm) on the incidence of adhesions and subsequent small-bowel obstruction and chronic abdominal complaints after colorectal surgery (Hartmann's procedure). BACKGROUND:Adhesi...
journal_title:Annals of surgery
pub_type: 杂志文章,随机对照试验
doi:10.1097/SLA.0b013e318217e99c
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:To evaluate the impact of health insurance expansion on racial disparities in severity of peripheral arterial disease. BACKGROUND:Lack of insurance and non-white race are associated with increased severity, increased amputation rates, and decreased revascularization rates in patients with peripheral artery d...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001310
更新日期:2016-04-01 00:00:00
abstract:INTRODUCTION:Advances in molecular biology have led to the identification of potential markers of prognostic and therapeutic importance in human cancers. HER-2 testing and targeted therapy now represents a critical cornerstone in the management of breast cancer. The objectives of the current study were to determine the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181dbb77e
更新日期:2010-06-01 00:00:00