老年卵圆孔未闭患者经导管封堵效果的单中心分析  

Single-center efficacy analysis of transcatheter closure for elderly patients with patent foramen ovale

作　　者：张蕾 张晓春 张源 李明飞 潘文志 陈莎莎 管丽华 周达新 葛均波 ZHANG Lei;ZHANG Xiao-chun;ZHANG Yuan;LI Ming-fei;PAN Wen-zhi;CHEN Sha-sha;GUAN Li-hua;ZHOU Da-xin;GE Jun-bo(Department of Cardiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心内科,上海200032

出　　处：《复旦学报（医学版）》2022年第3期376-383,共8页Fudan University Journal of Medical Sciences

摘　　要：目的探讨老年(≥60岁)卵圆孔未闭(patent foramen ovale,PFO)患者行经导管封堵预防脑血管事件再发的疗效和安全性。方法回顾性分析2013年1月至2017年12月在复旦大学附属中山医院接受PFO封堵治疗的患者共218例,年龄18~83岁,男性112例(51.4%),女例106例(48.6%)。按年龄分为非老年组(<60岁,n=180)和老年组(≥60岁,n=38)。收集和比较患者临床资料,包括术前合并症、术前心功能、超声心动图和右心导管资料、PFO封堵并发症并随访是否有脑缺血事件再发。运用Kaplan-Meier方法对所有封堵患者进行生存分析,并利用多因素Cox回归模型比较其预后因素。结果所有手术均在局部麻醉下经胸超声心动图引导完成。术前老年组具有高危形态学PFO的比例高于非老年组(36.8%vs.20.0%,P=0.025)。老年组和非老年组器械成功率和手术相关并发症差异均无统计学意义(P均为1.000)。中位随访时间13个月,两组短暂性脑缺血发作(transient ischemic attack,TIA)和缓慢性心律失常的发生率差异均无统计学意义(P=0.772和0.593),而老年组卒中复发和新发心房颤动(atrial fibrillation,AF)则高于非老年组(P=0.029和0.007)。Log-rank检验显示老年组的无事件生存率低于非老年组(P=0.019),只分析卒中和TIA终点,老年组也低于非老年组(P=0.004)。Cox多因素回归分析显示,在校正基线资料后,年龄≥60岁对于PFO封堵术后神经系统缺血性事件再发为独立于高血压和术前AF之外的风险因素(HR=1.237,95%CI:1.037~1.477,P=0.018)。结论老年PFO患者行经导管封堵术与非老年患者一样安全,在预防脑血管事件再发方面临床获益较年轻患者小,需要严格把握适应证,筛选合适的老年PFO患者进行封堵治疗。Objective To explore the efficacy and safety of transcatheter closure for patent foramen ovale(PFO)in elderly patients(≥60 years)to prevent recurrence of cerebrovascular events.Methods During Jan 2013 and Dec 2017,218 consecutive PFO patients having underwent transcatheter closure were retrospectively collected in Zhongshan Hospital,Fudan University.All patients were divided into two groups according to age:non-elderly group(<60 years,n=180)and elderly group(≥60 years,n=38).The clinical data including preoperative comorbidities,cardiac function,echocardiographic and right heart catheterization variables,PFO closure complications,and follow-up of recurrence rate of cerebral ischemia events were collected and analyzed.All survivals were reported by primary disease features using Kaplan-Meier methods and hazard ratios were derived from multivariate Cox models.Results All operations were completed under local anesthesia and guided by transthoracic echocardiography.The proportion of high risk PFO in the elderly group was higher than that in the non-elderly group(36.8%vs.20.0%,P=0.025).There were no statistically significant difference in the success rate of device implatation and surgery-related complications between two groups(both P=1.000).The median follow-up time was 13 months.There were no statistically significant difference in the incidence of recurrence of transient ischemic attack(TIA)and bradyarrhythmia between groups(P=0.772 and 0.593),but the rate of recurrence of stroke and new-onset atrial fibrillation(AF)were higher in the elderly group(P=0.029 and 0.007).Logrank test showed that the main clinical event-free survival of the elderly group was lower than that of the non-elderly group(P=0.019).The stroke/TIA event-free survival of the elderly group was still lower than that of the non-elderly group(P=0.004).After adjusting the baseline data,Cox multivariate regression analysis showed that the age is a risk factor for recurrence of neurological ischemic events after PFO closure independent from hyperten

关 键 词：卵圆孔未闭(PFO) 老年 经导管封堵 卒中 短暂性脑缺血发作(TIA) 

分 类 号：R743.31[医药卫生—神经病学与精神病学]