引言

幸運(yùn)的是，隨著心臟手術(shù)的重大進(jìn)步，過(guò)去可能不適合手術(shù)的老年患者現(xiàn)在也可考慮手術(shù)治療。對(duì)于手術(shù)和圍手術(shù)期幸存的患者，功能水平和生活質(zhì)量以及(在某些研究中)生存率與年齡匹配的一般人群受試者相似[3-5]。因此，只能對(duì)一般狀況極佳的老年患者考慮手術(shù)這一經(jīng)典觀念受到了挑戰(zhàn)，因?yàn)樵诠泊婕膊〔粐?yán)重或若不受控制也不會(huì)有嚴(yán)重影響的患者中取得了較高的手術(shù)成功率[6]。而且，經(jīng)皮瓣膜介入技術(shù)的出現(xiàn)將進(jìn)一步增加老年患者的治療選擇。事實(shí)上，經(jīng)導(dǎo)管主動(dòng)脈瓣置換術(shù)(transcatheter aortic valve replacement, TAVR)的成功促進(jìn)了二尖瓣及三尖瓣疾病處理的積極發(fā)展[7,8]。 (參見(jiàn)“癥狀性重度主動(dòng)脈瓣狹窄的治療選擇”)

研究使用了不同的年齡標(biāo)準(zhǔn)來(lái)界定老年人。雖然目前尚無(wú)關(guān)于心臟瓣膜病患病率的綜合人群數(shù)據(jù)，但有幾項(xiàng)研究提供了顯著心臟瓣膜病(根據(jù)年齡分層)患病率的重要信息(表 1)。老年人最常見(jiàn)的心臟瓣膜病有主動(dòng)脈瓣狹窄(aortic stenosis, AS)、器質(zhì)性和缺血性(功能性)二尖瓣反流以及三尖瓣反流。

主動(dòng)脈瓣狹窄

在轉(zhuǎn)診中心及療養(yǎng)院人群中也報(bào)道了類似的患病率，在90歲以上人群中患病率甚至更高[12,13]。

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