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Hofmann B, Rae E, Puvogel U, Spatarelu M, Mohamed SA, Bungaran A, Arzt S, Laux ML, Matschke K, Feyrer R, Sievers HH, Friedrich I, Niemann B, Silber RE, Wienke A, Simm A. Living Longer or Better-Patient's Choice in Cardiac Surgery Is Gender-Dependent-A Multicenter Study. J Clin Med 2023; 12:7596. [PMID: 38137666 PMCID: PMC10743955 DOI: 10.3390/jcm12247596] [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: 07/28/2023] [Revised: 11/08/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023] Open
Abstract
In view of the increasing age of cardiac surgery patients, questions arise about the expected postoperative quality of life and the hoped-for prolonged life expectancy. Little is known so far about how these, respectively, are weighted by the patients concerned. This study aims to obtain information on the patients' preferences. Between 2015 and 2017, data were analyzed from 1349 consecutive patients undergoing cardiac surgery at seven heart centers in Germany. Baseline data regarding the patient's situation as well as a questionnaire regarding quality of life versus lifespan were taken preoperatively. Patients were divided by age into four groups: below 60, 60-70, 70-80, and above 80 years. As a result, when asked to decide between quality of life and length of life, about 60% of the male patients opted for quality of life, independent of their age. On the other hand, female patients' preference for quality of life increased significantly with age, from 51% in the group below sixty to 76% in the group above eighty years. This finding suggests that female patients adapt their preferences with age, whereas male patients do not. This should impact further the treatment decisions of elderly patients in cardiac surgery within a shared decision-making process.
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Affiliation(s)
- Britt Hofmann
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (B.H.)
| | - Epp Rae
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (B.H.)
| | - Ulrike Puvogel
- Department of Cardiac and Vascular Surgery, 35392 Gießen, Germany
| | | | - Salah A. Mohamed
- Department of Cardiac and Thoracic Surgery, 23538 Lübeck, Germany
| | | | | | - Magdalena L. Laux
- Department of Cardiovascular Surgery, Heart Center Brandenburg, University Hospital Brandenburg Medical School, Faculty of Health Sciences Brandenburg, 16321 Bernau, Germany
| | | | | | | | | | - Bernd Niemann
- Department of Cardiac and Vascular Surgery, 35392 Gießen, Germany
| | - Rolf-Edgar Silber
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (B.H.)
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty, Martin-Luther-University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Andreas Simm
- Department of Cardiac Surgery, Mid-German Heart Center, University Hospital Halle (Saale), 06120 Halle (Saale), Germany; (B.H.)
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Saha S, Lang A, von der Linden J, Wassilowsky D, Peterss S, Pichlmaier M, Hagl C, Juchem G, Joskowiak D. Clinical Results and Quality of Life after Nonelective Cardiac Surgery in Octogenarians. Thorac Cardiovasc Surg 2022; 70:384-391. [DOI: 10.1055/s-0041-1730029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Abstract
Background We analyzed the short-term and mid-term outcomes as well as the health-related quality of life (HRQOL) of octogenarians undergoing elective and urgent cardiac surgery.
Patients and Methods We retrospectively identified 688 consecutive octogenarians who underwent cardiac surgery at our center between January 2012 and December 2019. A propensity score matching was performed which resulted in the formation of 80 matched pairs. The patients were interviewed and the Short Form-36 survey was used to assess the HRQOL of survivors. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model.
Results The median age of the matched cohort was 82 years (p = 0.937), among whom, 38.8% of patients were female (p = 0.196). The median EuroSCORE II of the matched cohort was 19.4% (10.1–39.1%). The duration of postoperative mechanical ventilation was found to be independently associated with in-hospital mortality (odds ratio: 1.01 [95% confidence interval: 1.0–1.02], p = 0.038). The survival rates at 1, 2, and 5 years was 75.0, 72.0, and 46.0%, respectively. There was no difference in the total survival between the groups (p = 0.080). The physical health summary score was 41 (30–51) for the elective patients and 42 (35–49) for the nonelective octogenarians (p = 0.581). The median mental health summary scores were 56 (48–60) and 58 (52–60), respectively (p = 0.351).
Conclusion Cardiac surgery can be performed in octogenarians with good results and survivors enjoy a good quality of life; however, the indication for surgery or especially for escalation of therapy should always be made prudently, reserved, and in consideration of patient expectations.
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Affiliation(s)
- Shekhar Saha
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Andrea Lang
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | | | - Dietmar Wassilowsky
- Department of Anesthesiology, Ludwig Maximilian University of Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | | | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Gerd Juchem
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
| | - Dominik Joskowiak
- Department of Cardiac Surgery, Ludwig Maximilian University of Munich, Germany
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Habib AM, Hussain A, Jarvis M, Cowen ME, Chaudhry MA, Loubani M, Cale A, Ngaage DL. Changing clinical profiles and in-hospital outcomes of octogenarians undergoing cardiac surgery over 18 years: a single-centre experience†. Interact Cardiovasc Thorac Surg 2019; 28:602-606. [PMID: 30412242 DOI: 10.1093/icvts/ivy293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/21/2018] [Accepted: 09/16/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES With an ageing population, increasing numbers of octogenarians are undergoing high-risk cardiac surgery. We examine the changing characteristics and in-hospital outcomes for octogenarians over an 18-year period. METHODS Clinical data from our prospective database for all octogenarians who had cardiac surgery from March 1999 through May 2016 were reviewed. We examined trends, risk profiles and in-hospital outcomes over 3 eras, namely early (1999-2004), middle (2005-2010) and late (2011-2016). A multivariable analysis was performed to identify independent predictors for adverse outcomes. RESULTS There were 1022 patients aged 80-94 years in our study cohort. The octogenarian population increased progressively from early to late eras (4.5%, n = 255 vs 7.1%, n = 321 vs 9.3%, n = 446), as the average logistic EuroSCORE predicted mortality (9% vs 9.7% vs 10.1%, P < 0.01). On the contrary, observed mortality declined substantially (9.4% vs 7.8% vs 4.7%, P = 0.04) over this period. While cardiac morbidity and respiratory comorbidities were more prevalent in the late era, chronic renal failure was more frequent in the early era. Over time, more procedures were performed electively (P = 0.05). Common operations across all eras were coronary artery bypass grafting (CABG), aortic valve replacement and CABG + aortic valve replacement. Emergency operation [odds ratio (OR) 4.96, 95% confidence interval (CI) 1.51-16.35; P < 0.01], poor ejection fraction (OR 3.38, 95% CI 1.80-6.32; P < 0.01) and bypass time (OR 1.01, 95% CI 1.00-1.02; P < 0.01) were predictors of in-hospital mortality. The late era of surgery (OR 0.41, 95% CI 0.23-0.73; P < 0.01) was associated with reduced mortality risk. CONCLUSIONS The operative outcome in this growing surgical population is steadily improving despite the increasing prevalence of comorbidities, and surgery should be performed electively as much as possible.
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Affiliation(s)
- Ahmed M Habib
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK.,Department of Cardiothoracic Surgery, Ain Shams University Hospitals, Cairo, Egypt
| | - Azhar Hussain
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Martin Jarvis
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Michael E Cowen
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Mubarak A Chaudhry
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Mahmoud Loubani
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Alex Cale
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
| | - Dumbor L Ngaage
- Department of Cardiothoracic Surgery, Castle Hill Hospital, Cottingham, East Yorkshire, UK
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Samalavičius R, Puodžiukaitė L, Abraitis V, Norkienė I, Ščupakova N, Pekarskienė J, Zorinas A, Ručinskas K, Šerpytis P. Successful extracorporeal membrane oxygenation assisted revascularisation in a high-risk elderly patient refused surgical treatment. Acta Med Litu 2019; 26:205-210. [PMID: 32355458 PMCID: PMC7180410 DOI: 10.6001/actamedica.v26i4.4205] [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: 08/09/2019] [Accepted: 09/04/2019] [Indexed: 11/27/2022] Open
Abstract
Management of high-risk elderly patients requiring revascularisation remains a clinical challenge. We report a case of extracorporeal membrane oxygenation (ECMO) assisted complex percutaneous coronary intervention in a high-risk octogenarian. An 83-year-old female with signs of worsening heart failure was admitted to the emergency department of a tertiary care facility. Transthoracic echocardiography revealed a decreased left ventricular ejection fraction of 20% with severe mitral regurgitation and mild aortic and tricuspid valve insufficiency. Three-vessel disease was found during coronary angiography. Due to the patient's frailty, a high-risk surgery decision to proceed with ECMO assisted percutaneous coronary intervention was made during a heart team meeting. Following initiation of mechanical support, coronary lesions were treated with three drug-eluting stents. After the procedure, the patient was transferred to the ICU on ECMO support, where she was successfully weaned from the device 9 h later. Her ICU stay was four days. She was successfully discharged from the hospital after uneventful recovery. At one-year's follow-up, the patient was clinically stable in an overall state of general well-being and with complete participation in routine activities; she had good exercise tolerance and no signs of ischemia. This report highlights the possibility of use of ECMO during PCI in high-risk elderly patients.
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Affiliation(s)
- Robertas Samalavičius
- 2nd Department of Anaesthesiology, Centre of Anaesthesiology,
Intensive Care and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius,
Lithuania
| | - Lina Puodžiukaitė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
| | - Vytautas Abraitis
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
| | - Ieva Norkienė
- Clinic of Anaesthesiology and Intensive Care, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
| | - Nadežda Ščupakova
- 2nd Department of Anaesthesiology, Centre of Anaesthesiology,
Intensive Care and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius,
Lithuania
| | - Justina Pekarskienė
- 2nd Department of Anaesthesiology, Centre of Anaesthesiology,
Intensive Care and Pain Management, Vilnius University Hospital Santaros Klinikos, Vilnius,
Lithuania
| | - Aleksejus Zorinas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
| | - Pranas Šerpytis
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine,
Vilnius University, Vilnius, Lithuania
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Medication adherence and quality of life in coronary artery bypass grafting patients, results of retrospective cohort study. Anatol J Cardiol 2018; 16:895-896. [PMID: 27872438 PMCID: PMC5324905 DOI: 10.14744/anatoljcardiol.2016.7398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Geis N, Raake P, Mereles D, Chorianopoulos E, Szabo G, Katus HA, Bekeredjian R, Pleger ST. Percutaneous repair of severe mitral valve regurgitation secondary to chordae rupture in octogenarians using MitraClip. J Interv Cardiol 2017; 31:76-82. [DOI: 10.1111/joic.12455] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/06/2017] [Accepted: 09/13/2017] [Indexed: 11/27/2022] Open
Affiliation(s)
- Nicolas Geis
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Philip Raake
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Derliz Mereles
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Emmanuel Chorianopoulos
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Gabor Szabo
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Hugo A. Katus
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Raffi Bekeredjian
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
| | - Sven T. Pleger
- Department of Internal Medicine III; Division of Cardiology; University of Heidelberg; Heidelberg Germany
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Survival, quality of life and impact of right heart failure in patients with acute cardiogenic shock treated with ECMO. Heart Lung 2016; 45:409-15. [PMID: 27515989 DOI: 10.1016/j.hrtlng.2016.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanical circulatory support is increasingly used in acute cardiogenic shock. OBJECTIVE To assess treatment strategies for cardiogenic shock. METHODS Data of 57 patients in acute intrinsic cardiogenic shock treated with ECMO were analyzed. Different subsequent strategies (weaning, VAD, transplantation) were followed. RESULTS Overall 1, 2, and 4-year survival was 36.8 ± 6.4%, 32.2 ± 6.4%, 29.8 ± 6.3%. Elevated lactate and hemorrhagic complications (all p in patients with right heart failure prior to ECMO implantation, BVAD therapy showed a trend (p=0.058) towards superior survival compared with LVAD therapy. Seven of the BVAD patients received successful transplantation, with a 1-year survival of 71%. Among survivors Short Form 36 reported significantly lower combined physical scores (p=0.004). CONCLUSIONS Right heart assessment prior to ECMO implantation may be beneficial to provide tailored therapy if ECMO weaning fails. Survival after cardiogenic shock requiring ECMO seems to be associated with impaired long-term quality of life.
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