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Taghizadeh-Waghefi A, Petrov A, Arzt S, Alexiou K, Tugtekin SM, Matschke K, Kappert U, Wilbring M. Clinical Outcomes after Multivalve Surgery in Octogenarians: Evaluating the Need for a Paradigm Shift. J Clin Med 2024; 13:745. [PMID: 38337441 PMCID: PMC10856504 DOI: 10.3390/jcm13030745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
(1) Background: this study addresses the lack of comprehensive research on outcomes in octogenarians undergoing cardiac surgery for multivalvular disease, emphasizing the need for a critical examination of the intervention's overall worth in this aging population. (2) Methods: By analyzing short-term and mid-term data from 101 consecutive octogenarian patients undergoing multivalve surgery, the study identifies predictors for in-hospital and one-year mortality. (3) Results: In-hospital mortality increased fourfold with the occurrence of at least one postoperative complication. Octogenarians undergoing multivalve surgery experienced an in-hospital mortality rate of 13.9% and an overall one-year mortality rate of 43.8%. Postoperative delirium was identified as an independent risk factor, contributing to elevated risks of both in-hospital and one-year mortality. Prolonged surgical procedure time emerged as an independent risk factor associated with increased in-hospital mortality. Continuous veno-venous hemodialysis showed an independent impact on in-hospital mortality. Both re-intubation and the transfusion of packed red blood cells were identified as independent risk factors for one-year mortality. (4) Conclusions: This study urges a critical examination of the justification for multivalve surgeries in high-risk elderly patients, emphasizing a paradigm shift. It advocates for interdisciplinary collaboration and innovative strategies, such as staged hybrid procedures, to improve therapeutic approaches for this challenging patient group to achieve a better therapeutic outcome for these patients.
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Affiliation(s)
- Ali Taghizadeh-Waghefi
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Asen Petrov
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Sebastian Arzt
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Konstantin Alexiou
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Sems-Malte Tugtekin
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Klaus Matschke
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Utz Kappert
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
| | - Manuel Wilbring
- Medical Faculty “Carl Gustav Carus”, Technical University of Dresden, 01307 Dresden, Germany (M.W.)
- Center of Minimally Invasive Cardiac Surgery, University Heart Center Dresden, Medical Faculty of the Technical University of Dresden, 01037 Dresden, Germany
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Bishawi M, Hattler B, Almassi GH, Quin JA, Grover FL, Collins JF, Ebrahimi R, Wolbrom DH, Shroyer AL. Health-related quality of life impacts upon 5-year survival after coronary artery bypass surgery. J Card Surg 2022; 37:4899-4905. [PMID: 36423254 DOI: 10.1111/jocs.17165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 10/27/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor preoperative health-related quality of life (HRQoL) has been associated with reduced short-term survival after coronary artery bypass graft (CABG) surgery; however, its impact on long-term mortality is unknown. This study's objective was to determine if baseline HRQoL status predicts 5-year post-CABG mortality. METHODS This prespecified, randomized on/off bypass follow-up study (ROOBY-FS) subanalysis compared baseline patient characteristics and HRQoL scores, obtained from the Seattle Angina Questionnaire (SAQ) and Veterans RAND Short Form-36 (VR-36), between 5-year post-CABG survivors and nonsurvivors. Standardized subscores were calculated for each questionnaire. Multivariable logistic regression assessed whether HRQoL survey subcomponents independently predicted 5-year mortality (p ≤ .05). RESULTS Of the 2203 ROOBY-FS enrollees, 2104 (95.5%) completed baseline surveys. Significant differences between 5-year post-CABG deaths (n = 286) and survivors (n = 1818) included age, history of chronic obstructive pulmonary disease, stroke, peripheral vascular disease, renal dysfunction, diabetes, lower left ventricular ejection fraction, atrial fibrillation, depression, non-White race/ethnicity, lower education status, and off-pump CABG. Adjusting for these factors, baseline VR-36 physical component summary score (p = .01), VR-36 mental component summary score (p < .001), and SAQ physical limitation score (p = .003) were all associated with 5-year all-cause mortality. CONCLUSIONS Pre-CABG HRQoL scores may provide clinically relevant prognostic information beyond traditional risk models and prove useful for patient-provider shared decision-making and enhancing pre-CABG informed consent.
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Affiliation(s)
- Muath Bishawi
- Department of Surgery, Duke University, Durham, North Carolina, USA
| | - Brack Hattler
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado, USA.,Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Hossein Almassi
- Department of Surgery, Clement J. Zablocki Veterans Affairs (VA) Medical Center, Milwaukee, Wisconsin, USA.,Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Jacquelyn A Quin
- Department of Surgery, Division of Cardiac Surgery, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Frederick L Grover
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Joseph F Collins
- Cooperative Studies Program Coordinating Center, Veterans Affairs Medical Center, Perry Point, Maryland, USA
| | - Ramin Ebrahimi
- Department of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Daniel H Wolbrom
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
| | - A Laurie Shroyer
- Northport Veterans Affairs Medical Center, Research and Development Office, Northport, New York, USA
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Outcomes of Octogenarians with Primary Malignant Cardiac Tumors: National Cancer Database Analysis. J Clin Med 2022; 11:jcm11164899. [PMID: 36013139 PMCID: PMC9410046 DOI: 10.3390/jcm11164899] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/09/2022] [Accepted: 08/17/2022] [Indexed: 11/16/2022] Open
Abstract
Data concerning age-related populations affected with primary malignant cardiac tumors (PMCTs) are still scarce. The aim of the current study was to analyze mortality differences amongst different age groups of patients with PMCTs, as reported by the National Cancer Database (NCDB). The NCDB was retrospectively reviewed for PMCTs from 2004 to 2017. The primary outcome was late mortality differences amongst different age categories (octogenarian, septuagenarian, younger age), while secondary outcomes included differences in treatment patterns and perioperative (30-day) mortality. A total of 736 patients were included, including 72 (9.8%) septuagenarians and 44 (5.98%) octogenarians. Angiosarcoma was the most prevalent PMCT. Surgery was performed in 432 (58.7%) patients (60.3%, 55.6%, and 40.9% in younger age, septuagenarian, and octogenarian, respectively, p = 0.04), with a corresponding 30-day mortality of 9.0% (7.0, 15.0, and 38.9% respectively, p < 0.001) and a median overall survival of 15.7 months (18.1, 8.7, and 4.5 months respectively). Using multivariable Cox regression, independent predictors of late mortality included octogenarian, governmental insurance, CDCC grade II/III, earlier year of diagnosis, angiosarcoma, stage III/IV, and absence of surgery/chemotherapy. With increasing age, patients presented a more significant comorbidity burden compared to younger ones and were treated more conservatively. Early and late survival outcomes progressively declined with advanced age.
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4
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Mikus E, Calvi S, Albertini A, Tripodi A, Zucchetta F, Brega C, Pin M, Cimaglia P, Ferrari R, Campo G, Serenelli M. Impact of comorbidities on older patients undergoing open heart surgery. J Cardiovasc Med (Hagerstown) 2022; 23:318-324. [PMID: 35013050 DOI: 10.2459/jcm.0000000000001296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The number of elderly patients undergoing cardiac surgery is increasing. Age greater than 80 years has been identified as a strong independent risk factor for shortand long-term survival. The current study is aimed to identify the impact of preoperative comorbidities on early and late outcomes in older patients undergoing cardiac surgery. METHODS Baseline characteristics, procedurals and postoperative complications of all patients undergoing cardiac surgery at our institution are collected. The current analysis is focused on patients aged at least 80 years at the time of intervention and treated from January 2010 to December 2019. RESULTS In-hospital mortality resulted as 6.3%. Redo intervention [odds ratio (OR) 2.49, 95% confidence interval (CI) 1.13-5.48], chronic obstructive pulmonary disease (COPD) (OR 2.99, 95% CI 1.75-5.12) and peripheral arterial disease (PAD) (OR 2.23, 95% CI 1.30-3.81) were independent baseline predictors of outcome in the multivariate analysis. Prolonged extracorporeal circulation time, need for transfusion and prolonged intubation time strongly and independently predicted in-hospital mortality. During a mean follow-up of 3.6 years 34.3% of patients died and unplanned admission (HR 1.33, 95% CI 1.05-1.67), NYHA class III-IV (HR 1.35, 95% CI 1.12-1.64), diabetes (HR 1.27, 95% CI 1.01-1.59), COPD (HR 1.60, 95% CI 1.25-2.04) and PAD (HR 1.32, 95% CI 1.03-1.71) resulted as independent predictors of all-cause death. CONCLUSION Cardiac surgery is feasible in octogenarians, with an acceptable risk of mortality. Chronological age itself should not be the main determinant of choice while referring patients for cardiac surgical intervention. Comorbidities such as COPD, PAD and diabetes need to be taken into account for risk stratification.
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Affiliation(s)
- Elisa Mikus
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | - Simone Calvi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | | | | | | | - Maurizio Pin
- Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | - Roberto Ferrari
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
| | - Matteo Serenelli
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, Italy
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5
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Jones JM, Loubani M, Grant SW, Goodwin AT, Trivedi U, Kendall S, Jenkins DP. Cardiac surgery in older patients: hospital outcomes during a 15-year period from a complete national series. Interact Cardiovasc Thorac Surg 2021; 34:532-539. [PMID: 34788460 PMCID: PMC8972229 DOI: 10.1093/icvts/ivab320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 09/23/2021] [Accepted: 10/18/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- James Mark Jones
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Mahmoud Loubani
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Stuart W Grant
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Division of Cardiovascular Sciences, University of Manchester, UK
| | - Andrew T Goodwin
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - Uday Trivedi
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Simon Kendall
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,James Cook University Hospital, Middlesbrough, UK
| | - David P Jenkins
- Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK.,Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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6
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Duncan AE. Commentary: Eighty is not the new 50: Recognizing risk in the elderly surgical patient. J Thorac Cardiovasc Surg 2020; 162:1578-1579. [PMID: 32513489 DOI: 10.1016/j.jtcvs.2020.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Andra E Duncan
- Department of Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, Ohio.
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7
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Kitahara H, McCrorey M, Patel B, Nisivaco S, Balkhy HH. Benefit of Robotic Beating-Heart Totally Endoscopic Coronary Artery Bypass in Octogenarians. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:531-536. [PMID: 31533515 DOI: 10.1177/1556984519876901] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE An important advantage of robotic beating-heart totally endoscopic coronary artery bypass (TECAB) is early functional recovery, in which fragile patients like octogenarians (age >80 years) benefit most. The aim of this study was to investigate the safety and feasibility of TECAB in octogenarians. METHODS We retrospectively reviewed patients undergoing TECAB from July 2013 to September 2017 at our institution. Perioperative outcomes of octogenarian patients and that of younger patients were compared. RESULTS Of 308 patients who underwent TECAB, 28 patients (9.1%) were octogenarians (mean age 83.8 ± 3.0 years). Octogenarians had a higher rate of hypertension and atrial fibrillation compared to younger patients. TECAB was successfully performed without conversion to any larger incisions in octogenarians. Mean operative time (299 ± 83 minutes vs 281 ± 89 minutes, P = 0.309) and the rate of multivessel bypass (60.7% vs 58.2%, P = 0.798) were similar between octogenarians and younger patients. New atrial fibrillation was observed more frequently in octogenarians compared to younger patients (35.7% vs 18.6%, P = 0.031). Mean length of hospital stay was similar between the 2 groups (octogenarians: 3.9 ± 1.8 days vs younger patients: 3.5 ± 3.0 days, P = 0.475). Twenty-two octogenarians (78.6%) were discharged directly to home. In-hospital mortality was zero in octogenarians. CONCLUSIONS Robotic beating-heart TECAB had favorable results in octogenarians with acceptable morbidity and mortality and excellent short length of stay similar to younger patients.
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Affiliation(s)
- Hiroto Kitahara
- Department of Surgery, University of Chicago Medicine, IL, USA
| | | | - Brooke Patel
- Department of Surgery, University of Chicago Medicine, IL, USA
| | - Sarah Nisivaco
- Department of Surgery, University of Chicago Medicine, IL, USA
| | - Husam H Balkhy
- Department of Surgery, University of Chicago Medicine, IL, USA
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