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Galloo X, Stassen J, Butcher SC, Meucci MC, Dietz MF, Mertens BJA, Prihadi EA, van der Bijl P, Ajmone Marsan N, Braun J, Bax JJ, Delgado V. Staging right heart failure in patients with tricuspid regurgitation undergoing tricuspid surgery. Eur J Cardiothorac Surg 2022; 62:6576630. [PMID: 35511132 PMCID: PMC9789688 DOI: 10.1093/ejcts/ezac290] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/26/2022] [Accepted: 04/28/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study evaluated the prognostic value of staging right heart failure in patients with significant tricuspid regurgitation (TR) undergoing tricuspid valve (TV) surgery. METHODS Patients with significant TR who underwent TV surgery were divided into 4 right heart failure stages according to the presence of right ventricular (RV) dysfunction and clinical signs of right heart failure: stage 1 was defined as no RV dysfunction and no signs of right heart failure; stage 2 indicated RV dysfunction without signs of right heart failure; stage 3 included RV dysfunction and signs of right heart failure; and stage 4 was defined as RV dysfunction and refractory signs of right heart failure at rest. RESULTS A total of 278 patients [mean age 64 (12), 49% males] were included, of whom 34 (12%) patients were classified as stages 1 and 2, 141 (51%) as stage 3 and 103 (37%) as stage 4 right heart failure. The majority of patients (91%) had TV surgery concomitant to left-sided valve surgery or coronary artery bypass grafting and 95% underwent TV annuloplasty. Cumulative survival rates were 89%, 78% and 61% at 1 month, 1 year and 5 years, respectively. Stages 1 and 2 and stage 3 were independently associated with better survival compared to stage 4 (hazard ratio: 0.391 [95% confidence interval: 0.186-0.823] and 0.548 [95% confidence interval: 0.369-0.813], respectively). CONCLUSIONS Patients with significant TR undergoing TV surgery and diagnosed without advanced right heart failure have better survival as compared to patients with right heart failure.
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Affiliation(s)
- Xavier Galloo
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiology, Royal Perth Hospital, Perth, Australia
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart, Rome, Italy
| | - Marlieke F Dietz
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Bart J A Mertens
- Department of Bioinformatics, Bioinformatics Centre of Expertise, Leiden University Medical Centre, Leiden, Netherlands
| | - Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerp, Belgium
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardio-Thoracic Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Heart Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands,Corresponding author. Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2330 RC Leiden, Netherlands. Tel: +31-715262020; fax: +31-715266809; e-mail: (V. Delgado)
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Clinical Characteristics and Long-Term Prognosis of Elderly Valvular Heart Disease Patients with Diabetes Mellitus: Five-Year Experience from a Single-Center Study of Southern China. Cardiol Res Pract 2021; 2021:2558639. [PMID: 34745659 PMCID: PMC8566085 DOI: 10.1155/2021/2558639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Diabetes mellitus (DM) is a prognostic marker in elderly patients with cardiovascular diseases, but its predictive value in elderly valvular heart disease (VHD) patients is unclear. This study aimed to investigate the effect of DM on the long-term outcome of elderly VHD patients. Methods This single-center, observational study enrolled patients aged 65 and older consecutively with confirmed VHD using echocardiography. Patients, divided into the DM group and non-DM group, were followed up for major adverse cardiac and cerebrovascular events (MACCEs), including all-cause death, ischemic stroke, and heart failure rehospitalization. Results Our study consisted of 532 patients over a median follow-up of 52.9 months. Compared with the non-DM group (n = 377), the DM group (n = 155) had higher incidences of ischemic stroke (25.2% vs. 13.5%, P=0.001), heart failure rehospitalization (37.4% vs. 20.7%, P < 0.001), and MACCEs (60.0% vs. 35.8%, P < 0.001). After adjustment of confounders by the multivariable cox regression, DM appeared as an independent predictor for MACCEs (adjusted hazard ratio, aHR: 1.88; 95% confidence interval 1.42–2.48; P < 0.001). In the subgroup analysis of VHD etiology and functional style, conversely, DM was a protective factor for MACCEs in the patients with rheumatic VHD compared with those without rheumatic VHD (aHR: 0.43 vs. 2.27, P=0.004). Conclusions DM was an independent predictor for ischemic stroke and heart failure rehospitalization in elderly VHD patients undergoing conservative treatment.
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Performance of the EuroSCORE II and the STS score for cardiac surgery in octogenarians. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:174-182. [PMID: 34104511 PMCID: PMC8167478 DOI: 10.5606/tgkdc.dergisi.2021.21403] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/22/2021] [Indexed: 11/21/2022]
Abstract
Background
We aimed to investigate the predictive value of Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE II) scores for mortality in octogenarian cardiac surgery patients.
Methods
Between January 2016 and December 2019, cardiac operations performed in 116 octogenarian patients (73 males, 43 females; mean age: 82.9±3.1 years; range, 80 to 97 years) were retrospectively analyzed. The patients with and without mortality were compared for their demographic and operative factors. The STS and EuroSCORE II scores, and observed mortality rates were assessed.
Results
Mean STS score was 3.7±11.1 and mean EuroSCORE II was 5.2±5.4. For any operation type, the mean EuroSCORE II was significantly higher (8.1±7.4 vs. 4.1±4.0, respectively; p=0.006) in the patients with mortality. For elective operations, the mean EuroSCORE II was higher in cases with mortality (7.2±7.3 vs. 3.7±3.9, respectively; p=0.006); however, for urgent cases, there was no significant difference between the scores. Using the receiver operating characteristic curve, the EuroSCORE II had a higher area under the curve for all cases and elective cases than the STS scores.
Conclusion
The EuroSCORE II performed better than the STS score for mortality prediction in octogenarians, whereas the predictions of either scoring system was unsatisfactory for urgent surgery and combined procedures. Population-based validation studies are needed for a better risk scoring system in this age group.
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Kodali SK, Velagapudi P, Hahn RT, Abbott D, Leon MB. Valvular Heart Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2019; 71:2058-2072. [PMID: 29724358 DOI: 10.1016/j.jacc.2018.03.459] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/23/2022]
Abstract
In the United States, the octogenarian population is projected to triple by 2050. With this aging population, the prevalence of valvular heart disease (VHD) is on the rise. The etiology, approach to treatment, and expected outcomes of VHD are different in the elderly compared with younger patients. Both stenotic and regurgitant lesions are associated with unfavorable outcomes if left untreated. Surgical mortality remains high due to multiple co-morbidities, and long-term survival benefit is dependent on many variables including valvular pathology. Quality of life is an important consideration in treatment decisions in this age group. Increasingly, octogenarian patients are receiving transcatheter therapies, with transcatheter aortic valve replacement having the greatest momentum. Numerous transcatheter devices for management of other valve lesions are currently in early clinical trials. This review will describe the epidemiology, etiology, diagnosis, and therapeutic options for VHD in the oldest old, with a focus on transcatheter technologies.
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Affiliation(s)
- Susheel K Kodali
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York.
| | - Poonam Velagapudi
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | - Rebecca T Hahn
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
| | | | - Martin B Leon
- Columbia University Medical Center/New York Presbyterian Hospital, New York, New York
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Jebran AF, Saha S, Waezi N, Al-Ahmad A, Niehaus H, Danner BC, Baraki H, Kutschka I. Design and training effects of a physical reality simulator for minimally invasive mitral valve surgery. Interact Cardiovasc Thorac Surg 2019; 29:409-415. [DOI: 10.1093/icvts/ivz112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 03/18/2019] [Accepted: 03/20/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
Minimally invasive mitral valve surgery (MIMVS) through an endoscopic right minithoracotomy is a well-established yet complex procedure that has a challenging learning curve. We have developed a simulator for MIMVS and evaluated its short- and long-term training effects.
METHODS
Trainees without simulator experience or training in MIMVS were divided into 2 groups (10 students and 10 residents) and participated in a 5-day training course after initial instruction. Each trainee performed a ring annuloplasty. Scores were given by a supervisor who assessed 5 skills. The duration of each procedure was also measured. To evaluate the long-term effect of the training course, trainees performed the same procedure 4 weeks after the last session.
RESULTS
Trainees in the resident group were significantly older compared to those in the student group and had a mean surgical experience of 4.4 ± 0.78 years standard error of the mean. All other demographic data were similar. Significant learning curves could be achieved in both groups over the course of 5 days with regard to total skill scores and total duration. However, when we compared the learning curves of both groups, no significant difference could be seen. Long-term performance in both groups was still significantly better compared to that in the first training session.
CONCLUSIONS
Training with our simulator provided a significant enhancement of a trainee’s performance. This learning effect was achieved in both groups and was still evident 4 weeks later. We strongly recommend our simulator for simulation-based surgical education of cardiac surgeons interested in MIMVS.
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Affiliation(s)
- Ahmad-Fawad Jebran
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Shekhar Saha
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Narges Waezi
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Ammar Al-Ahmad
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Heidi Niehaus
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Bernhard C Danner
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Hassina Baraki
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
| | - Ingo Kutschka
- Department of Thoracic and Cardiovascular Surgery, Georg-August-University, Goettingen, Germany
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Rostagno C. Heart valve disease in elderly. World J Cardiol 2019; 11:71-83. [PMID: 30820277 PMCID: PMC6391621 DOI: 10.4330/wjc.v11.i2.71] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/13/2019] [Accepted: 01/26/2019] [Indexed: 02/06/2023] Open
Abstract
The incidence of heart valve disease increases significantly with age. Degenerative abnormalities associated with severe aortic stenosis and mitral and tricuspid regurgitation are found in not less than 10% of the population aged ≥ 75 years. Surgical treatment has been considered for years to be the treatment of choice. However, it was not uncommonly associated with high perioperative morbidity and mortality due to frequent comorbidities and overall frailty conditions of these patients. Conventional risk scores such as Society of Thoracic Surgeons and European System for Cardiac Operative Risk Evaluation may underestimate the risk of surgery in elderly patients, leading to inappropriate surgical indication. On the other hand, at least 30% of patients with severe conditions are left untreated due to prohibitive surgical risk. Interventional procedures, which are in continuous development, may be actually considered for high risk patients and, as recent results suggest, also for intermediate risk patients.
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Affiliation(s)
- Carlo Rostagno
- Department of Internal Medicine, University of Florence, Florence 50134, Italy
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Gavina C. Epidemiology of valvular heart disease in Portugal: The time has come for the heart valve unit. Rev Port Cardiol 2018; 37:999-1000. [PMID: 30559035 DOI: 10.1016/j.repc.2018.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Cristina Gavina
- Serviço de Cardiologia, Hospital Pedro Hispano- Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.
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Gavina C. Epidemiology of valvular heart disease in Portugal: The time has come for the heart valve unit. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Quality of life in elder adults one-year after coronary bypass. JOURNAL OF VASCULAR NURSING 2017; 34:152-157. [PMID: 27863593 DOI: 10.1016/j.jvn.2016.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 06/29/2016] [Accepted: 07/06/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Survival rates in the elderly after cardiac surgery have improved over the last decades and therewith more attention is directed toward Quality of Life (QoL) as a patient reported outcome measure. OBJECTIVE The purpose of this study was to explore QoL in patients one year after coronary artery bypass grafting, with special interest in the elderly patients (≥80 years). METHODS In a quantitative, retrospective single-center study patients with isolated coronary artery bypass grafting (eg, nonvalve) surgery aged 80 years or older and operated in 2013 were included (n = 32). A control group of patients aged younger than 80 years was selected by matching based on gender and a recalculated (for age) logistic European System for Cardiac Operative Risk Evaluation (log EuroSCORE I) during the same period (n = 48). QoL assessment by the EuroQol questionnaire (EQ-5D) and additional questions were performed at one-year follow-up. RESULTS QoL in elderly patients was 0.79 versus 0.90 in younger patients (P = 0.013). Overall, 54.8% of the elderly experience some or extreme problems in mobility versus 18.8% in the younger group (P = 0.001). Elderly patients also experience more problems in self care (19.3 vs 4.2%, P = 0.029). Nine of the elderly (29%) valued their postoperative health status to be worse than preoperatively versus 5 (10%) in the younger group (P = 0.028). Only patients aged 80 years or older would choose not to have surgery again (12.9%). Hospital mortality was 3.1% in the elderly group (n = 32) and 0% in the younger group (n = 48). CONCLUSION Not all elderly patients experience benefits in terms of QoL one year after cardiac surgery. Therefore, potential benefits and risks need to be considered and discussed by physicians and patients before making the decision to operate or not.
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Fudulu D, Lewis H, Benedetto U, Caputo M, Angelini G, Vohra HA. Minimally invasive aortic valve replacement in high risk patient groups. J Thorac Dis 2017; 9:1672-1696. [PMID: 28740685 DOI: 10.21037/jtd.2017.05.21] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts.
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Affiliation(s)
- Daniel Fudulu
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Harriet Lewis
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Gianni Angelini
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery, University Bristol Hospitals NHS Foundation Trust, Bristol, UK
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Augustin P, Tanaka S, Chhor V, Provenchère S, Arnaudovski D, Ibrahim H, Dilly MP, Allou N, Montravers P, Philip I. Prognosis of Prolonged Intensive Care Unit Stay After Aortic Valve Replacement for Severe Aortic Stenosis in Octogenarians. J Cardiothorac Vasc Anesth 2016; 30:1555-1561. [PMID: 27720290 DOI: 10.1053/j.jvca.2016.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Octogenarians considered for cardiac surgery encounter more complications than other patients. Postoperative complications raise the question of continuation of high-cost care for patients with limited life expectancy. Duration of hospitalization in intensive care after cardiac surgery may differ between octogenarians and other patients. The objectives were evaluating the mortality rate of octogenarians experiencing prolonged hospitalization in intensive care and defining the best cut-off for prolonged intensive care unit length of stay. DESIGN A single-center observational study. SETTING A postoperative surgical intensive care unit in a tertiary teaching hospital in Paris, France. PARTICIPANTS All consecutive patients older than 80 years considered for aortic valve replacement for aortic stenosis were included. MEASUREMENTS AND MAIN RESULTS Mortality rate was determined among patients experiencing prolonged stay in intensive care with organ failure and without organ failure. An ROC curve determined the optimal cut-off defining prolonged hospitalization in intensive care according to the occurrence of postoperative complications. Multivariate analysis determined risk factors for early death or prolonged intensive care stay. The optimal cut-off defining prolonged intensive care unit length of stay was 4 days. Low ventricular ejection fraction (odds ratio [OR] = 0.95; 95% confidence interval [CI] 0.96-0.83; p = 0.0016), coronary disease (OR = 2.34; 95% CI 1.19-4.85; p = 0.014), and need for catecholamine (OR = 2.79; 95% CI 1.33-5.88; p = 0.0068) were associated with eventful postoperative course. There was not a hospitalization duration beyond which the prognosis significantly worsened. CONCLUSIONS Prolonged length of stay in ICU without organ failure is not associated with increased mortality. No specific duration of hospitalization in intensive care was associated with increased mortality. Continuation of care should be discussed on an individual basis.
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Affiliation(s)
- Pascal Augustin
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France.
| | - Sebastien Tanaka
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Vibol Chhor
- †Département d'Anesthésie Réanimation Chirurgicale, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris 5, René Descartes, Paris, France
| | - Sophie Provenchère
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Darko Arnaudovski
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Hassan Ibrahim
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Marie-Pierre Dilly
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Nicolas Allou
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Philippe Montravers
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France
| | - Ivan Philip
- Département d'Anesthésie Réanimation Chirurgicale, Groupe Hospitalier Bichat Claude Bernard, Assistance Publique-Hôpitaux de Paris, Université Paris 7, Denis Diderot, Paris, France; ‡Service d'Anesthésie, Institut Mutualiste Montsouris, Paris, France
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Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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13
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Aortic valve replacement for severe aortic stenosis in octogenarians: Patient outcomes and comparison of operative risk scores. Rev Port Cardiol 2015; 34:439-46. [DOI: 10.1016/j.repc.2015.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/02/2015] [Indexed: 11/17/2022] Open
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Incidence, Severity, and Outcomes of Acute Kidney Injury in Octogenarians following Heart Valve Replacement Surgery. Int J Nephrol 2015; 2015:237951. [PMID: 26090225 PMCID: PMC4458288 DOI: 10.1155/2015/237951] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/05/2015] [Accepted: 04/23/2015] [Indexed: 01/16/2023] Open
Abstract
Background. The study investigates the occurrence, severity, and outcomes of acute kidney injury (AKI) in octogenarians following heart valve surgery. Methods. All patients, age >80 years, not on dialysis and without kidney transplant, undergoing heart valve replacement at Mayo Clinic, Rochester, in the years 2002-2003 were enrolled. AKI was diagnosed based on AKIN criteria. Results. 209 octogenarians (88.0% aortic valve, 6.2% mitral valve, 1.0% tricuspid valve, and 4.8% multivalve) with (58.4%) and without CABG were studied. 34 (16.3%) had preexisting CKD. After surgery, 98 (46.8%) developed AKI. 76.5% of the AKI were in Stage 1, 9.2% in Stage 2, and 14.3% in Stage 3. 76.5% CKD patients developed AKI. Length of hospital stay was longer for AKI patients. More AKI patients were discharged to care facilities. Patient survival at 30 days and 1 year for AKI versus non-AKI was 88.8 versus 98.7%, p = 0.003, and 76.5 versus 88.3%, p = 0.025, respectively. With follow-up of 3.94 ± 0.28 years, Kaplan-Meier analysis showed a reduced survival for AKI octogenarians. Preexisting CKD and large volume intraoperative
fluid administration were independent AKI predictors. Conclusions. Nearly half of the octogenarians developed AKI after valve replacement surgery. AKI was associated with significant functional impairment and reduced survival.
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Gilmanov D, Farneti PA, Ferrarini M, Santarelli F, Murzi M, Miceli A, Solinas M, Glauber M. Full sternotomy versus right anterior minithoracotomy for isolated aortic valve replacement in octogenarians: a propensity-matched study. Interact Cardiovasc Thorac Surg 2015; 20:732-41; discussion 741. [DOI: 10.1093/icvts/ivv030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/23/2015] [Indexed: 11/12/2022] Open
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Milano AD, Dodonov M, Van Oeveren W, Onorati F, Gu YJ, Tessari M, Menon T, Gottin L, Faggian G. Pulsatile cardiopulmonary bypass and renal function in elderly patients undergoing aortic valve surgery†. Eur J Cardiothorac Surg 2014; 47:291-8; discussion 298. [DOI: 10.1093/ejcts/ezu136] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Biancari F, Schifano P, Pighi M, Vasques F, Juvonen T, Vinco G. Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression. J Cardiothorac Vasc Anesth 2013; 27:213-9. [PMID: 23507013 DOI: 10.1053/j.jvca.2012.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The authors evaluated the outcome of patients≥80 years undergoing mitral valve (MV) surgery. DESIGN Systematic review of the literature and meta-analysis. SETTING None. PARTICIPANTS None. INTERVENTIONS None. MAIN RESULTS Twenty-four studies reporting on 5,572 patients ≥80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other than isolated MV surgery (p = 0.010), MV surgery associated with coronary artery surgery (p = 0.029), aortic cross-clamping time (p<0.001), and cardiopulmonary bypass time (p<0.001) were associated significantly with increased operative mortality. MV repair had lower operative mortality compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% CI 0.342-0.962). Random-effects metaregression showed that prolonged aortic cross-clamping time (p = 0.005) was the only determinant of increased operative mortality, even when adjusted (p<0.001) for date of study (p = 0.004). Operative mortality was significantly higher in studies reporting a mean cross-clamp time >90 minutes (17.0% v 7.4%, p<0.001). Survival rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively. CONCLUSIONS MV surgery in patients ≥80 years of age is associated with operative mortality, which has decreased significantly during recent years. Prolonged aortic cross-clamp time is a major determinant of operative mortality. MV repair may achieve better results than MV replacement in the very elderly. Five-year survival of these patients is good and justifies surgical treatment of MV diseases in octogenarians.
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Affiliation(s)
- Fausto Biancari
- Department of Surgery, Oulu University Hospital, Oulu, Finland.
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Soppa G, Woodford C, Yates M, Shetty R, Moore M, Valencia O, Fletcher N, Jahangiri M. Functional status and survival after prolonged intensive care unit stay following cardiac surgery. Interact Cardiovasc Thorac Surg 2013; 16:750-4. [PMID: 23482373 DOI: 10.1093/icvts/ivt046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The clinical outcomes of patients discharged after prolonged postoperative intensive care unit (ICU) stay following cardiac surgery are unclear. The aim of this study was to assess survival and functional status in patients whose ICU stay exceeded 5 or 10 days in a tertiary cardiac surgical unit. METHODS Patients undergoing adult cardiac surgery between October 2008 and October 2010 who stayed in an ICU for 5-10 days (Group A) or >10 days (Group B) were studied. Demographics, operative details and postoperative data were prospectively collected. The follow-up of all patients was performed by telephone questionnaire. Functional status was assessed using the Karnofsky performance score by only one investigator for uniformity of scoring. For those patients who could not be contacted, the electronic patient records and data from the UK Office for National Statistics were reviewed to determine mortality. RESULTS Between 2008 and 2010, 2250 patients underwent adult cardiac surgery. Of these, 108 (4.7%) patients stayed >5 days (Group A, n = 53 and Group B, n = 55) in the ICU, having undergone various adult cardiac surgical procedures. The mean logistic EuroSCORE was 13 (range 1.5-86) for Group A and 16 (range 1-78) for Group B (P = 0.11). The mean ICU stay was 7 (range 6-8 days) for Group A and 21 (range 10-78 days) for Group B. Death in ICU occurred in 7 (13%) Group A patients and 11 (20%) Group B patients (P = 0.34). The median follow-up of patients who survived to the hospital discharge was 30 (range 13-38 months). Of the 90 survivors discharged from the hospital, there were 13 (25%) late deaths in Group A and 26 (47%) in Group B (P = 0.02). All survivors were contacted for the assessment of their functional status. The mean Karnofsky scores for Group A and Group B were 87 (range 70-100%) and 77.3% (range 40-100%), respectively, indicating satisfactory functional status. CONCLUSIONS Patients who have a prolonged ICU stay following cardiac surgery have high early and late mortalities. However, the functional status of the survivors is satisfactory after 1 year and beyond.
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Affiliation(s)
- Gopal Soppa
- Department of Cardiac Surgery, St. George's Hospital, London, UK
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Outcome of patients aged ≥80 years undergoing combined aortic valve replacement and coronary artery bypass grafting: a systematic review and meta-analysis of 40 studies. Am Heart J 2012; 164:410-418.e1. [PMID: 22980309 DOI: 10.1016/j.ahj.2012.06.019] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 06/23/2012] [Indexed: 11/24/2022]
Abstract
AIM This study was planned to evaluate the outcome of patients aged ≥80 years undergoing combined conventional aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). METHODS This is a systematic review of the literature and meta-analysis of data on patients aged ≥80 years who underwent combined AVR and CABG. RESULTS The literature search yielded 40 observational studies reporting on 8,975 patients aged ≥80 years. Pooled proportion of immediate postoperative mortality was 9.7% (95% CI 8.4-11.1, 40 studies, 8,975 patients). Immediate mortality was 8.2% (95% CI 6.5-10.0) in 15 studies with a mid-date from 2000 to 2007 and 10.8% (95% CI 9.1-12.7) in 25 studies with a mid-date from 1982 to 1999 (P = .043). Postoperative stroke rate was 3.7% (95% CI 2.8-4.8, 12 studies, 2,770 patients), and postoperative implantation of pacemaker was 4.3% (95% CI 2.6-6.5, 5 studies, 535 patients). The mean length of stay in intensive care unit was 5.3 days (95% CI 3.3-7.3, 5 studies, 490 patients), and the mean length of in-hospital stay was 16.9 days (95% CI 12.4-21.4, 5 studies, 424 patients). One-, 3-, 5- and 10-year pooled survival rates after combined AVR and CABG were 83.2%, 72.9%, 60.8%, and 25.7%, respectively. CONCLUSIONS Conventional AVR and CABG in patients aged ≥80 years are associated with significant operative mortality and morbidity as well as prolonged in-hospital treatment. However, conventional surgery is associated with remarkably good late survival. This suggests that any alternative treatment modality must prove itself of being enough durable also in the very elderly.
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Bockeria LA, Skopin II, Tsiskaridze IM, Danilov GV. eComment. Posterior mitral leaflet chordal replacement in the elderly. Interact Cardiovasc Thorac Surg 2012; 15:549; discussion 549. [PMID: 22908184 DOI: 10.1093/icvts/ivs348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Leo A Bockeria
- Bakoulev Center for Cardiovascular Surgery, Russian Academy of Medical Sciences, Moscow, Russia
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Comparison of goal-directed hemodynamic optimization using pulmonary artery catheter and transpulmonary thermodilution in combined valve repair: a randomized clinical trial. Crit Care Res Pract 2012; 2012:821218. [PMID: 22611489 PMCID: PMC3350845 DOI: 10.1155/2012/821218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 02/14/2012] [Indexed: 01/20/2023] Open
Abstract
Our aim was to compare the effects of goal-directed therapy guided either by pulmonary artery catheter (PAC) or by transpulmonary thermodilution (TTD) combined with monitoring of oxygen transport on perioperative hemodynamics and outcome after complex elective valve surgery.
Measurements and Main Results. Forty patients were randomized into two equal groups: a PAC group and a TTD group. In the PAC group, therapy was guided by mean arterial pressure (MAP), cardiac index (CI) and pulmonary artery occlusion pressure (PAOP), whereas in the TTD group we additionally used global end-diastolic volume index (GEDVI), extravascular lung water index (EVLWI), and oxygen delivery index (DO2I). We observed a gradual increase in GEDVI, whereas EVLWI and PAOP decreased by 20–30% postoperatively (P < 0.05). The TTD group received 20% more fluid accompanied by increased stroke volume index and DO2I by 15–20% compared to the PAC group (P < 0.05). Duration of mechanical ventilation was increased by 5.2 hrs in the PAC group (P = 0.04).
Conclusions. As compared to the PAC-guided algorithm, goal-directed therapy based on transpulmonary thermodilution and oxygen transport increases the volume of fluid therapy, improves hemodynamics and DO2I, and reduces the duration of respiratory support after complex valve surgery.
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Gelsomino S, Lorusso R, Livi U, Masullo G, Lucà F, Maessen J, Gensini GF. Cost and cost-effectiveness of cardiac surgery in elderly patients. J Thorac Cardiovasc Surg 2011; 142:1062-73. [DOI: 10.1016/j.jtcvs.2011.02.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 01/07/2011] [Accepted: 02/09/2011] [Indexed: 11/28/2022]
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Tissot CM, Attias D, Himbert D, Ducrocq G, Iung B, Dilly MP, Juliard JM, Lepage L, Détaint D, Messika-Zeitoun D, Nataf P, Vahanian A. Reappraisal of percutaneous aortic balloon valvuloplasty as a preliminary treatment strategy in the transcatheter aortic valve implantation era. EUROINTERVENTION 2011; 7:49-56. [DOI: 10.4244/eijv7i1a11] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Poor performances of EuroSCORE and CARE score for prediction of perioperative mortality in octogenarians undergoing aortic valve replacement for aortic stenosis. Eur J Anaesthesiol 2011; 27:702-7. [PMID: 20520558 DOI: 10.1097/eja.0b013e32833a45de] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Although results of cardiac surgery are improving, octogenarians have a higher procedure-related mortality and more complications with increased length of stay in ICU. Consequently, careful evaluation of perioperative risk seems necessary. The aims of our study were to assess and compare the performances of EuroSCORE and CARE score in the prediction of perioperative mortality among octogenarians undergoing aortic valve replacement for aortic stenosis and to compare these predictive performances with those obtained in younger patients. METHODS This retrospective study included all consecutive patients undergoing cardiac surgery in our institution between November 2005 and December 2007. For each patient, risk assessment for mortality was performed using logistic EuroSCORE, additive EuroSCORE and CARE score. The main outcome measure was early postoperative mortality. Predictive performances of these scores were assessed by calibration and discrimination using goodness-of-fit test and area under the receiver operating characteristic curve, respectively. RESULTS During this 2-year period, we studied 2117 patients, among whom 134/211 octogenarians and 335/1906 nonoctogenarians underwent an aortic valve replacement for aortic stenosis. When considering patients with aortic stenosis, discrimination was poor in octogenarians and the difference from nonoctogenarians was significant for each score (0.58, 0.59 and 0.56 vs. 0.82, 0.81 and 0.77 for additive EuroSCORE, logistic EuroSCORE and CARE score in octogenarians and nonoctogenarians, respectively, P < 0.05). Moreover, in the whole cohort, logistic EuroSCORE significantly overestimated mortality among octogenarians. CONCLUSION Predictive performances of these scores are poor in octogenarians undergoing cardiac surgery, especially aortic valve replacement. Risk assessment and therapeutic decisions in octogenarians should not be made with these scoring systems alone.
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Viana-Tejedor A, Domínguez FJ, Moreno Yangüela M, Moreno R, López de Sá E, Mesa JM, López-Sendón J. Cirugía cardíaca en pacientes octogenarios. Factores predictores de mortalidad y evaluación de la supervivencia y la calidad de vida a largo plazo. Med Clin (Barc) 2008; 131:412-5. [DOI: 10.1157/13126216] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bockeria LA, Skopin II, Kuts EV. eComment: prospective assessment of quality of life of octogenarians after cardiac surgery. Interact Cardiovasc Thorac Surg 2008; 7:818. [PMID: 18801807 DOI: 10.1510/icvts.2008.178095a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Leo A Bockeria
- Bakoulev Center for Cardiovascular Surgery, 121552 Moscow, Russia
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de Lange F, Yoshitani K, Podgoreanu MV, Grocott HP, Mackensen GB. A novel survival model of cardioplegic arrest and cardiopulmonary bypass in rats: a methodology paper. J Cardiothorac Surg 2008; 3:51. [PMID: 18713467 PMCID: PMC2553064 DOI: 10.1186/1749-8090-3-51] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 08/19/2008] [Indexed: 11/18/2022] Open
Abstract
Background Given the growing population of cardiac surgery patients with impaired preoperative cardiac function and rapidly expanding surgical techniques, continued efforts to improve myocardial protection strategies are warranted. Prior research is mostly limited to either large animal models or ex vivo preparations. We developed a new in vivo survival model that combines administration of antegrade cardioplegia with endoaortic crossclamping during cardiopulmonary bypass (CPB) in the rat. Methods Sprague-Dawley rats were cannulated for CPB (n = 10). With ultrasound guidance, a 3.5 mm balloon angioplasty catheter was positioned via the right common carotid artery with its tip proximal to the aortic valve. To initiate cardioplegic arrest, the balloon was inflated and cardioplegia solution injected. After 30 min of cardioplegic arrest, the balloon was deflated, ventilation resumed, and rats were weaned from CPB and recovered. To rule out any evidence of cerebral ischemia due to right carotid artery ligation, animals were neurologically tested on postoperative day 14, and their brains histologically assessed. Results Thirty minutes of cardioplegic arrest was successfully established in all animals. Functional assessment revealed no neurologic deficits, and histology demonstrated no gross neuronal damage. Conclusion This novel small animal CPB model with cardioplegic arrest allows for both the study of myocardial ischemia-reperfusion injury as well as new cardioprotective strategies. Major advantages of this model include its overall feasibility and cost effectiveness. In future experiments long-term echocardiographic outcomes as well as enzymatic, genetic, and histologic characterization of myocardial injury can be assessed. In the field of myocardial protection, rodent models will be an important avenue of research.
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Affiliation(s)
- Fellery de Lange
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA.
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Kogan A, Ghosh P, Preisman S, Tager S, Sternik L, Lavee J, Kasiff I, Raanani E. Risk Factors for Failed “Fast-Tracking” After Cardiac Surgery in Patients Older Than 70 Years. J Cardiothorac Vasc Anesth 2008; 22:530-5. [DOI: 10.1053/j.jvca.2008.02.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Indexed: 11/11/2022]
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Outcomes in Special Populations Undergoing Cardiac Surgery: Octogenarians, Women, and Adults with Congenital Heart Disease. Crit Care Nurs Clin North Am 2007; 19:467-85, vii. [DOI: 10.1016/j.ccell.2007.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Calvo D, Lozano I, Llosa JC, Lee DH, Martín M, Avanzas P, Valle JM, Morís C. Cirugía de recambio valvular por estenosis aórtica severa en mayores de 80 años. Experiencia de un centro en una serie de pacientes consecutivos. Rev Esp Cardiol 2007. [DOI: 10.1157/13108277] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Pritisanac A, Gulbins H, Rosendahl U, Ennker J. Outcome of heart surgery procedures in octogenarians: is age really not an issue? Expert Rev Cardiovasc Ther 2007; 5:243-50. [PMID: 17338669 DOI: 10.1586/14779072.5.2.243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Survival rates are a well-known marker for quality performance of a cardiac surgery department, as well as standard of procedures, freedom of reoperation, postoperative complications, length of hospital stay, improvement in New York Heart Association classification and quality of life after surgery. Until recently there has not been any great interest of surgeons in topics concerning the costs of postoperative care, as long as the results were successful. However, satisfactory results after cardiac surgery in aged people require successful procedures, as well as meticulous perioperative care. The expenses of healthcare are constantly growing and approaches to optimize costs in all departments of medicine have a high priority. Exact evaluation of comorbidities and prevention of complications in aged people, as well as attentive strategies concerning expenses, may help to reduce mortality, postoperative complications and costs.
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Affiliation(s)
- Anita Pritisanac
- Heart Institute Lahr/Baden, Department of Cardio-Thoracic and Vascular Surgery, Hohbergweg 2, 77933 Lahr, Germany.
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Eitz T, Fritzsche D, Kleikamp G, Zittermann A, Horstkotte D, Körfer R. Reoperation of the Aortic Valve in Octogenarians. Ann Thorac Surg 2006; 82:1385-90. [PMID: 16996938 DOI: 10.1016/j.athoracsur.2006.04.093] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 04/26/2006] [Accepted: 04/27/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Because of increasing life expectancy of patients with heart valve replacement and a limited durability of heart valve bioprostheses, cardiac reoperation becomes necessary in a significant percentage of patients. Reliable data on mortality and risk factors in octogenarians after replacement of aortic valve prostheses are scanty, however. METHODS We retrospectively analyzed 71 patients aged 80 years and older who underwent cardiac reoperation of the aortic valve (69 bioprostheses, 2 mechanical prostheses) between 1991 and 2004 at our heart center. Survival rate of the study cohort was compared with a control group of octogenarians matched for age, sex, and year of aortic valve replacement. To assess predictors of 30-day survival and 3-year survival, we performed univariate and multivariate analyses. RESULTS Survival rates at 30 days, 1 year, 3 years and 5 years were 83.6%, 76.1%, 70.8%, and 51.3%, respectively. Results did not differ significantly between the study cohort and the controls. Patients with reoperation had an estimated median survival of 5.6 years. Postoperative complications such as low cardiac output syndrome and intestinal failure were the only independent predictors of 30-day survival (p = 0.020 and p = 0.015, respectively). Low cardiac output, intestinal failure, and diabetes mellitus were independent predictors of 3-year survival (p = 0.001 to 0.033). CONCLUSIONS Our data demonstrate that it is possible to achieve an acceptable outcome in octogenarians who have reoperation of the aortic valve prosthesis. Early and mid-term survival is predominantly influenced by unexpected postoperative complications and not by preoperative risk factors, with the exception of diabetes mellitus.
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Affiliation(s)
- Thomas Eitz
- Department of Cardiothoracic Surgery, Heart and Diabetes Center NRW, North-Rhine Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany.
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Wasywich CA, Ruygrok PN, West TM, Haydock DA. Extended follow up after isolated aortic valve replacement in the elderly. Heart Lung Circ 2003; 12:103-7. [PMID: 16352116 DOI: 10.1046/j.1444-2892.2003.00196.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present paper reviews the extended follow up of all patients aged >/=70 who underwent isolated aortic valve replacement at our institution in the 1980s. Patients were identified from the surgical database and clinical information was gathered. Long-term follow up information was obtained from the patient, their family, or doctor. Ninety-three patients aged >/=70 years (median 73, range 70-80) comprised the study population. The indication for surgery was aortic stenosis in 68 patients (73%). Fifty-two patients (56%) received an allograft valve, 17 (18%) a bioprosthetic valve, and 24 (26%) a mechanical prosthesis. The median hospital stay was 12 days (range 0-105 days). Five surgical deaths occurred. Detailed follow up was obtained for the 71 patients who died later, and the 16 living patients (one patient lost). The median length of follow up was 6.8 years (range 0.1-18.9 years). Patients who received an allograft aortic valve had a significantly better long-term survival (median 10.6, 95% confidence intervals (CI) 8.1-13.8 years) compared to those receiving mechanical or bioprosthetic valves (median 6.5, 95% CI 4.7-11.9 years), P = 0.03. For the entire group, survival was similar to the age- and sex-matched population. Of the 16 patients alive at follow up (mean age 87, range 83-92), most were free of angina (12, 75%) and heart failure (10, 63%). The conclusion from the current study is that isolated aortic valve surgery in the elderly, particularly with an allograft valve, is associated with an excellent long-term outcome. A survival benefit was demonstrated comparing allograft aortic valve replacement to other valve types.
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Affiliation(s)
- Cara A Wasywich
- Departments of Cardiology and Cardiothoracic Surgery, Green Lane Hospital, Auckland, New Zealand
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Engoren M, Arslanian-Engoren C, Steckel D, Neihardt J, Fenn-Buderer N. Cost, outcome, and functional status in octogenarians and septuagenarians after cardiac surgery. Chest 2002; 122:1309-15. [PMID: 12377858 DOI: 10.1378/chest.122.4.1309] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To evaluate cost, outcome, and functional status of octogenarians and septuagenarians after cardiac surgery. DESIGN Observational case control study. Retrospective analysis of hospital cost and outcome. Prospective analysis of functional status at 1 to 2 years. PATIENTS One hundred three consecutive octogenarians and 103 randomly selected septuagenarians who underwent cardiac surgery. SETTING A university-affiliated tertiary care center. MEASUREMENTS AND RESULTS Compared to septuagenarians, octogenarians were more likely to be widowed (p < or = 0.001) and to have had preoperative strokes (p < or = 0.05) but were less likely to have diabetes mellitus (p < or = 0.001). They were less likely to have undergone mitral valve surgery (p < or = 0.01) but were more likely to have undergone coronary artery bypass graft surgery without cardiopulmonary bypass (p < or = 0.001). The hospital mortality rate was 6% in the younger group and 9% in the older group (odds ratio, 1.5; 95% confidence interval [CI], 0.5 to 4.5; p > 0.05). In patients undergoing isolated CABG, the mortality rate was 1.4% in the septuagenarians and 8.2% in the octogenarians (odds ratio, 6.2; 95% CI, 0.7 to 52.7; p = 0.12). Despite similar ICU, postoperative, and total lengths of stay, the median hospital direct variable cost was 35% higher for the octogenarians. At late follow-up, octogenarians had lower levels of physical functioning and general health but otherwise had levels of function that were similar to those of septuagenarians. CONCLUSION Cardiac surgery can be performed in the elderly with good hospital and late functional results, but at a higher hospital cost than that for younger patients.
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Affiliation(s)
- Milo Engoren
- Department of Anesthesiology, St. Vincent Mercy Medical Center, 2213 Cherry Street, Toledo, OH 43608, USA.
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Brunvand H, Offstad J, Nitter-Hauge S, Svennevig JL. Coronary artery bypass grafting combined with aortic valve replacement in healthy octogenarians does not increase postoperative risk. SCAND CARDIOVASC J 2002; 36:297-301. [PMID: 12470398 DOI: 10.1080/140174302320774519] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Critical aortic stenosis with or without coronary artery disease is increasingly common in octogenarians. Surgery is the treatment of choice, but indications and results of aortic valve replacement (AVR), particularly when combined with coronary artery bypass grafting (CABG) are debated. We investigated whether the combined procedure of AVR and CABG increased postoperative risk compared with isolated AVR in otherwise healthy octogenarians. DESIGN In the period 1994-1998, AVR was performed in 94 patients above 80 years, the majority in NYHA class III and IV. Combined AVR and CABG was performed in 52/94 patients. The patients were studied retrospectively by collecting data from hospital records and followed for 0-7 years. RESULTS Mean age was 82 +/- 2.3 years, sex (male/female) 33/61, left ventricular ejection fraction 70 +/- 18%, transvalvular peak pressure gradient 63 +/- 20 mmHg and aortic valve area 0.5 +/- 0.2 cm(2). Early mortality (< 30 days) was 4/42 (9.5%) after AVR and 4/52 (7.6%) after AVR and CABG (p = NS between groups). Three-year survival was 33/42 (78.5%) after AVR and 42/52 (80.7%) after AVR and CABG (p = NS between groups). CONCLUSION AVR with concomitant CABG in octogenarians with aortic stenosis who are otherwise healthy, may be performed without increased risk.
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Affiliation(s)
- Harald Brunvand
- Department of Cardiology, Rikshospitalet, University of Oslo, Norway.
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Dudley N. Importance of risk communication and decision making in cardiovascular conditions in older patients: a discussion paper. Qual Health Care 2001. [PMID: 11533433 DOI: 10.1136/qhc.0100019..] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2022]
Abstract
Atrial fibrillation and aortic stenosis commonly present doctors and patients with difficult decisions about the risks and benefits of treatment options and are both often inappropriately undertreated. Patients may be confused by risk information and doctors may be aware of patients' limitations and use this to manipulate choices to the ones desired by the doctors. This paper examines the importance of risk communication and discusses difficulties that can arise in decision making in these two common cardiovascular conditions.
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Affiliation(s)
- N Dudley
- St James's University Hospital, Leeds LS9 7TF, UK.
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Dudley N. Importance of risk communication and decision making in cardiovascular conditions in older patients: a discussion paper. Qual Health Care 2001; 10 Suppl 1:i19-22. [PMID: 11533433 PMCID: PMC1765741 DOI: 10.1136/qhc.0100019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Atrial fibrillation and aortic stenosis commonly present doctors and patients with difficult decisions about the risks and benefits of treatment options and are both often inappropriately undertreated. Patients may be confused by risk information and doctors may be aware of patients' limitations and use this to manipulate choices to the ones desired by the doctors. This paper examines the importance of risk communication and discusses difficulties that can arise in decision making in these two common cardiovascular conditions.
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Affiliation(s)
- N Dudley
- St James's University Hospital, Leeds LS9 7TF, UK.
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