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Bibo L, Goldblatt J, Cohen R, Merry C, Larbalestier R. Coronary artery bypass grafting in octogenarians: an Australian experience. ANZ J Surg 2024; 94:1065-1070. [PMID: 38361308 DOI: 10.1111/ans.18902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 10/18/2023] [Accepted: 01/30/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND The aims of this study were to describe early and mid-term morbidity and mortality in octogenarian patients undergoing CABG, to determine if outcomes are comparable to younger patients undergoing the same procedure. METHODS We conducted a retrospective analysis of the first 901 patients who underwent cardiac surgery at a large newly established tertiary hospital in Western Australia from February 2015 to September 2019. Inclusion criteria involved all patients undergoing coronary artery bypass grafting. Exclusion criteria included patients who underwent concomitant valve or aortic procedure. RESULTS From a cohort of 901 patients, 37 octogenarian patients underwent CABG. Octogenarian patients had a higher rate of post-operative transfusion 35.1% versus 21.4% (P = 0.048), a higher rate of post-op acute kidney injury 40.5% versus 17.2% (P < 0.0001), a higher rate of post-operative atrial arrythmia requiring treatment 40.5% versus 22.5% (P = 0.011) and higher rate of return to theatre (13.5% versus 4.7%, P = 0.018), with bleeding/tamponade being the most likely reason (10.8% versus 2.7%). Octogenarian patients had a longer post-operative length of stay (LOS) with a median LOS of 10 versus 7 days (P < 0.0001). There was no increase in hospital readmission rate, in-hospital mortality or 1 year mortality in octogenarian patients. 24-month and 36-month survivals were 95.2% and 89.6% in octogenarians and 95.3% and 91.5% in the younger group. CONCLUSIONS Despite an increase in post-operative morbidity and LOS, there was no difference in hospital readmission, in-hospital mortality or 1 year mortality in octogenarian patients who underwent CABG. CABG is safe and remains an important management option for these patients.
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Affiliation(s)
- Liam Bibo
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Joshua Goldblatt
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Ryan Cohen
- School of Biomedical Science, University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Chris Merry
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
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2
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Oezpeker UC, Hoefer D, Barbieri F, Gollmann-Tepekoeylue C, Johannes H, Clemens E, Suat E, Adel S, Sasa R, Mueller L, Grimm M, Bonaros N. Isolated annuloplasty in elderly patients with secondary mitral valve regurgitation: short- and long-term outcomes with a less invasive approach. Front Cardiovasc Med 2023; 10:1193156. [PMID: 37915742 PMCID: PMC10617676 DOI: 10.3389/fcvm.2023.1193156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 09/06/2023] [Indexed: 11/03/2023] Open
Abstract
Background Long-term outcomes of elderly and frail patients with secondary mitral valve regurgitation (MR) are inconclusive. Especially in patients with co-morbidities such as atherosclerosis who are suffering from heart failure, optimal medical therapy (OMT) is the preferred therapy relative to surgical or percutaneous interventions. It remains challenging to identify the most successful therapy to improve symptoms and increase life expectancy. To reduce surgical trauma for these patients, minimally invasive mitral valve surgery (MIMVS) was developed; this has shown promising medium-term results, but there is still a lack of evidence regarding long-term results. The aim of this investigation was to describe the long-term outcomes of less invasive mitral valve surgery (MVS) in elderly patients. Methods In this longitudinal retrospective analysis, 67 patients (aged ≥70 years) with secondary MR who underwent MV repair ± tricuspid valve repair (TVR) were identified. MVS was performed via minithoracotomy (MT) in most cases (n = 54); in patients with contraindications for MIMVS, partial upper sternotomy (PS) was the preferred route for surgical access (n = 13). The appropriate access route was chosen according to the patient's clinical condition and comorbidities. We analyzed reoperation-free long-term survival, combined operative success (lack of residual MR, conversion to MV replacement, or larger thoracic incisions), and perioperative safety (at 30 days: mortality, re-thoracotomy, ECMO, pacemaker implantation, dialysis, longer ventilation, stroke, myocardial infarction). In a subgroup analysis, we compared long-term survival in MVS patients with and without TVR. Results The median age of patients (62.7% female) was 74 years (interquartile range: 72-76 years), with a median EuroSCORE2 of 2.8% (1.5%-4.6%) and N-terminal pro-brain natriuretic peptide plasma levels of 1,434 ng/L (1035-2149 ng/L). The median follow-up period was 5.6 years (2.7-8.5 years). The reoperation-free long-term survival rate up to 10 years was 66.2%. Combined operative success and perioperative safety were achieved in 94% and 76% of patients, respectively. Additional TVR was performed in 56.7% of patients, without any significant difference in survival rates compared to the group without TVR (p = 0.417; HR 1.473, 95% CI 0.578-3.757). Conclusion Less invasive MV repair for secondary MR shows excellent operative success and safety in selected patients. Freedom from significant MR and from the need for reoperation indicates long-lasting efficacy. These results should be considered in heart team discussions regarding allocation of patients to surgical mitral procedures.
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Affiliation(s)
- Ulvi Cenk Oezpeker
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniel Hoefer
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Fabian Barbieri
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Department of Cardiology, Angiology and Intensive Care Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany
| | | | - Holfeld Johannes
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Engler Clemens
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Ersahin Suat
- Department of Cardiovascular Surgery, Sakarya University, Adapazari, Türkiye
| | - Sakic Adel
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rajsic Sasa
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Ludwig Mueller
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
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3
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Pan R, Li X, Han J, Li Q, Lei Z, Huang H, Chen Y. Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting: a retrospective case-control study. BMC Anesthesiol 2023; 23:63. [PMID: 36855100 PMCID: PMC9972799 DOI: 10.1186/s12871-023-02024-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/20/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Frailty has been considered to be associated with major mortality and increased length of stay after cardiac surgery. This study aimed to explore the predictive potential of frailty assessment in the prognosis of elderly patients undergoing bypass surgery. METHODS This study assessed the preoperative frailty according to the Fried's frailty phenotype, and included 150 frail and 150 non-frail elderly patients (≥ 65 y) who underwent bypass surgery. The present study evaluated the prognosis of elderly patients based on sequential organ failure assessment (SOFA) score, and collected clinical indicators to construct logistic regression models with the prognosis as the dependent variable, to explore the potential predictive ability of preoperative frailty. Moreover, this study focused on the complications and analyzed the relationship between preoperative frailty and postoperative complications. RESULTS In the present study, 244 patients were divided into the favorable prognosis group and 56 patients were divided into the unfavorable prognosis group. Logistic regression analysis showed that increased myoglobin and high cardiac function classification were independent risk factors for unfavorable prognosis in elderly patients undergoing bypass surgery. The discrimination of the clinical prediction model was determined by the receiver operating characteristic (ROC) curve, and the area under curve (AUC) was 0.928. After adding preoperative frailty assessment, the AUC was improved to 0.939. This study found a significant correlation between preoperative frailty and postoperative complications, mainly in the circulatory system. CONCLUSION Preoperative frailty assessment could be a predictive factor for the prognosis of elderly patients undergoing coronary artery bypass grafting. According to our study, frailty assessment and appropriate intervention before bypass surgery may be beneficial to the enhanced recovery after cardiac surgery. TRIAL REGISTRATION The clinical study was approved by the Medical Ethics Committee of The First Affiliated Hospital of Nanjing Medical University (2021-SR-393). All patients signed an informed consent form.
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Affiliation(s)
- Rui Pan
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Xiaohui Li
- Department of Anesthesiology, the Fourth People's Hospital of Taizhou, 99 Gulou North Road, Hailing District, Taizhou City,, 225399, Jiangsu Province, China
| | - Jingjing Han
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Qian Li
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - Zheng Lei
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China
| | - He Huang
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China.
| | - Yu Chen
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Gulou District, Nanjing City, 210029, Jiangsu Province, China.
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Eranki A, Merakis M, Williams ML, Flynn CD, Villanueva C, Wilson-Smith A, Lee Y, Mejia R. Outcomes of surgery for acute type A dissection in octogenarians versus non-octogenarians: a systematic review and meta analysis. J Cardiothorac Surg 2022; 17:222. [PMID: 36050776 PMCID: PMC9434858 DOI: 10.1186/s13019-022-01980-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 08/26/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Acute Type A Aortic Dissection (ATAAD) is a cardiothoracic emergency that requires urgent intervention. Elderly status, particularly age over 80, is an independent risk factor for mortality and morbidity. The mid-term outcomes of this age group are also unknown. This systematic review and meta-analysis of observational studies was therefore performed to analyse short- and mid-term mortality and morbidity in octogenarians following surgery for ATAAD. METHODS A systematic review was conducted for studies published since January 2000. The primary endpoint was short-term mortality, either reported as 30-day mortality or in-hospital mortality and medium-term (five year) survival. Secondary endpoints were rates of postoperative complications, namely stroke, acute renal failure (ARF), re-exploration and intensive care unit (ICU) length of stay (LOS). RESULTS A total of 16 retrospective studies, with a total of 16, 641 patients were included in the systematic review and meta-analysis. Pooled analysis demonstrated that octogenarian cohorts are at significantly higher risk of short-term mortality than non-octogenarians (OR 1.93; 95% CI 1.33-2.81; P < 0.001). Actuarial survival was significantly lower in the octogenarian cohort, with a five-year survival in the octogenarian cohort of 54% compared to 76% in the non-octogenarian cohort (P < 0.001). There were no significant differences between the cohorts in terms of secondary outcomes: stroke, ARF, re-exploration or ICU LOS. CONCLUSION Octogenarians are twice as likely to die in the short-term following surgery for ATAAD and demonstrate a significantly lower five-year actuarial survival. Patients and family members should be well informed of the risks of surgery and suitable octogenarians selected for surgery.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.
| | - Michael Merakis
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Campbell D Flynn
- Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Claudia Villanueva
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Yangsin Lee
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, Australia
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5
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Eranki A, Wilson-Smith A, Williams ML, Saxena A, Mejia R. Quality of life following surgical repair of acute type A aortic dissection: a systematic review. J Cardiothorac Surg 2022; 17:118. [PMID: 35578309 PMCID: PMC9112611 DOI: 10.1186/s13019-022-01875-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/30/2022] [Indexed: 11/21/2022] Open
Abstract
Background The outcomes of surgery for acute Stanford Type A aortic dissection (ATAAD) extend beyond mortality and morbidity. The aim of this systematic review was to summarise the literature surrounding health related quality of life (HR-QOL) following ATAAD, compare the outcomes to the standardised population, and to assess the impact of advanced age on HRQOL outcomes following surgery. Methods A systematic review of studies after January 2000 was performed to identify HR-QOL in patients following surgery for ATAAD. Electronic searches of three databases were performed and clinical studies extracted by two independent reviewers. Strict inclusion and exclusion criteria were applied. Quality appraisal was conducted utilizing predefined criteria on pilot forms. HR-QOL results were synthesized through a narrative review of included studies. Results There was significant attrition in HR-QOL of patients following surgery for ATAAD. Outcomes fared worse when compared to an age adjusted normative population. Of note, elderly patients were physically vulnerable, whereas younger populations may be more mentally vulnerable to postoperative sequalae. The included studies were quite heterogeneous in their study designs, methods, HR-QOL measures reported and follow up time-frames which limited direct comparison between studies. Conclusion HR-QOL outcomes are adversely affected when compared to preoperative status and physical health demonstrates significant attrition over time. HR-QOL outcomes are worse off when compared to an age matched general population. In terms of age, advancing age is associated with worse physical component scores but emotional health may fare better than younger patients. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01875-x.
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Affiliation(s)
- Aditya Eranki
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.
| | - Ashley Wilson-Smith
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia
| | - Michael L Williams
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia.,The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Akshat Saxena
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Ross Mejia
- Department of Cardiothoracic Surgery, John Hunter Hospital, Newcastle, NSW, 2305, Australia
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Machado RJ, Saraiva FA, Mancio J, Sousa P, Cerqueira RJ, Barros AS, Lourenço AP, Leite-Moreira AF. A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:60-68. [PMID: 34792312 DOI: 10.23736/s0021-9509.21.12012-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM Comparison of short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 65 throughout a meta-analysis of randomized clinical trials (RCTs). EVIDENCE ACQUISITION A literature search was conducted using 3 databases. RCTs reporting mortality outcomes of OPCAB versus ONCAB among the elderly were included. Data on myocardial infarction, stroke, re-revascularization, renal failure and composite endpoints after CABG were also collected. Random effects models were used to compute statistical combined measures and 95% confidence intervals (CI). EVIDENCE SYNTHESIS Five RCTs encompassing 6221 patients were included (3105 OPCAB and 3116 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.89-1.17, p=0.80) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, p=0.72) between OPCAB and ONCAB. At 30-day, there were no differences in mortality, myocardial infarction, stroke and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, p=0.01), with a higher percentage of incomplete revascularization being reported for OPCAB in trials included in this pooled result (34% in OPCAB vs 29% in ONCAB, p<0.01). CONCLUSIONS Data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. OPCAB was associated with a higher risk of early rerevascularization. As CABG on the elderly is still insufficiently explored, further RCTs, specifically designed targeting this population, are needed to establish a better CABG strategy for these patients.
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Affiliation(s)
- Rui J Machado
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca A Saraiva
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jennifer Mancio
- Intensive Care and Perioperative Medicine Department, Royal Brompton and Harefield & Guys and St. Thomas NHS Foundation Trust, London, UK
| | - Patrícia Sousa
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui J Cerqueira
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - António S Barros
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal - .,Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
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7
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Atilgan K, Onuk BE, Köksal Coşkun P, Yeşi L FG, Aslan C, Çolak A, Çelebi AS, Bozbaş H. Remote patient monitoring after cardiac surgery: The utility of a novel telemedicine system. J Card Surg 2021; 36:4226-4234. [PMID: 34478205 PMCID: PMC9292885 DOI: 10.1111/jocs.15962] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022]
Abstract
Objective We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web‐based software. Methods From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web‐based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow‐up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. Results During a mean follow‐up period of 78.9 ± 107.1 (10–395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life‐threatening complications were found to have been diagnosed early using the Telemedicine System. Conclusion Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.
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Affiliation(s)
- Kıvanç Atilgan
- Department of Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
| | - Burak E Onuk
- Department of Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
| | | | - Fahri G Yeşi L
- Department of Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
| | - Cemal Aslan
- Department of Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
| | - Abdullah Çolak
- Department of Cardiovascular Surgery, TOBB ETU Hospital, Ankara, Turkey
| | | | - Hüseyin Bozbaş
- Department of Cardiology, TOBB ETU Hospital, Ankara, Turkey
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Ono M, Serruys PW, Hara H, Kawashima H, Gao C, Wang R, Takahashi K, O'Leary N, Wykrzykowska JJ, Sharif F, Piek JJ, Garg S, Mack MJ, Holmes DR, Morice MC, Head SJ, Kappetein AP, Thuijs DJFM, Noack T, Davierwala PM, Mohr FW, Cohen DJ, Onuma Y. 10-Year Follow-Up After Revascularization in Elderly Patients With Complex Coronary Artery Disease. J Am Coll Cardiol 2021; 77:2761-2773. [PMID: 34082905 DOI: 10.1016/j.jacc.2021.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal revascularization strategy for the elderly with complex coronary artery disease remains unclear. OBJECTIVES The goal of this study was to investigate 10-year all-cause mortality, life expectancy, 5-year major adverse cardiac or cerebrovascular events (MACCE), and 5-year quality of life (QOL) after percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) in elderly individuals (>70 years old) with 3-vessel disease (3VD) and/or left main disease (LMD). METHODS In the present pre-specified analysis on age of the SYNTAX Extended Survival study, 10-year all-cause death and 5-year MACCE were compared with Kaplan-Meier estimates and Cox proportional hazards models among elderly or nonelderly patients. Life expectancy was estimated by restricted mean survival time within 10 years, and QOL status according to the Seattle Angina Questionnaire up to 5 years was assessed by linear mixed-effects models. RESULTS Among 1,800 randomized patients, 575 patients (31.9%) were elderly. Ten-year mortality did not differ significantly between PCI and CABG in elderly (44.1% vs. 41.1%; hazard ratio [HR]: 1.08; 95% confidence interval [CI]: 0.84 to 1.40) and nonelderly patients (21.1% vs. 16.6%; HR: 1.30; 95% CI: 1.00 to 1.69; pinteraction = 0.332). Among elderly patients, 5-year MACCE was comparable between PCI and CABG (39.4% vs. 35.1%; HR: 1.18; 95% CI: 0.90 to 1.56), whereas it was significantly higher in PCI over CABG among nonelderly patients (36.3% vs. 23.0%; HR: 1.69; 95% CI: 1.36 to 2.10; pinteraction = 0.043). There were no significant difference in life expectancy (mean difference: 0.2 years in favor of CABG; 95% CI: -0.4 to 0.7) and 5-year QOL status between PCI and CABG among elderly patients. CONCLUSIONS Elderly patients with 3VD and/or LMD had comparable 10-year all-cause death, life expectancy, 5-year MACCE, and 5-year QOL status irrespective of revascularization mode. (Synergy Between PCI With TAXUS and Cardiac Surgery: SYNTAX Extended Survival [SYNTAXES]; NCT03417050) (SYNTAX Study: TAXUS Drug-Eluting Stent Versus Coronary Artery Bypass Surgery for the Treatment of Narrowed Arteries [SYNTAX]; NCT00114972).
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Affiliation(s)
- Masafumi Ono
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Patrick W Serruys
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; NHLI, Imperial College London, London, United Kingdom.
| | - Hironori Hara
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Hideyuki Kawashima
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Chao Gao
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Rutao Wang
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; Department of Cardiology, Radboud University, Nijmegen, the Netherlands
| | - Kuniaki Takahashi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Neil O'Leary
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
| | - Joanna J Wykrzykowska
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; University Medical Center Groningen, Groningen, the Netherlands
| | - Faisal Sharif
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland; CÚRAM-SFI Centre for Research in Medical Devices, Galway, Ireland
| | - Jan J Piek
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Scot Garg
- Department of Cardiology, Royal Blackburn Hospital, Blackburn, United Kingdom
| | - Michael J Mack
- Department of Cardiothoracic Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - David R Holmes
- Department of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Marie-Claude Morice
- Département of Cardiologie, Hôpital privé Jacques Cartier, Générale de Santé Massy, France
| | - Stuart J Head
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Arie Pieter Kappetein
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Daniel J F M Thuijs
- Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Thilo Noack
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Piroze M Davierwala
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - Friedrich W Mohr
- University Department of Cardiac Surgery, Heart Centre Leipzig, Leipzig, Germany
| | - David J Cohen
- Cardiovascular Research Foundation, New York, New York, USA; St. Francis Hospital, Roslyn, New York, USA
| | - Yoshinobu Onuma
- Department of Cardiology, National University of Ireland, Galway (NUIG), Galway, Ireland
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Blokzijl F, Keus F, Houterman S, Dieperink W, van der Horst ICC, Reneman MF, Absalom AR, Mariani MA. Does postoperative cognitive decline after coronary bypass affect quality of life? Open Heart 2021; 8:openhrt-2020-001569. [PMID: 33888591 PMCID: PMC8070880 DOI: 10.1136/openhrt-2020-001569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/12/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE This study aimed to explore the influence of coronary artery bypass grafting (CABG) on both postoperative cognitive dysfunction and quality of life (QoL) and the association between the two patient-related outcomes. METHODS In a prospective, observational cohort study, patients with elective, isolated CABG were included. Cognitive function was assessed using the Cogstate computerised cognitive test battery preoperatively, 3 days and 6 months after surgery. QoL was measured preoperatively and at 6 months using the RAND-36 questionnaire including the Physical Component Score (PCS) and the Mental Component Score (MCS). Regression analysis, with adjustment for confounders, was used to evaluate the association between postoperative cognitive dysfunction and QoL. RESULTS A total of 142 patients were included in the study. Evidence of persistent cognitive dysfunction was observed in 33% of patients after 6 months. At 6 months, the PCS had improved in 59% and decreased in 21% of patients, and the MCS increased in 49% and decreased in 29%. Postoperative cognitive changes were not associated with QoL scores. CONCLUSIONS Postoperative cognitive dysfunction and decreased QoL are common 6 months after surgery, although cognitive function and QoL were found to have improved in many patients at 6 months of follow-up. Impaired cognitive function is not associated with impaired QoL at 6 months. TRIAL REGISTRATION NUMBER NCT03774342.
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Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Saskia Houterman
- Department of Education and Research, Catharina Hospital, Eindhoven, The Netherlands
| | - Willem Dieperink
- Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University Medical Centre Groningen, Groningen, The Netherlands
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10
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Blokzijl F, Houterman S, van Straten BHM, Daeter E, Brandon Bravo Bruinsma GJ, Dieperink W, Reneman MF, Keus F, van der Horst ICC, Mariani MA. Quality of life after coronary bypass: a multicentre study of routinely collected health data in the Netherlands†. Eur J Cardiothorac Surg 2020; 56:526-533. [PMID: 30879073 PMCID: PMC6735900 DOI: 10.1093/ejcts/ezz051] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/11/2019] [Accepted: 01/31/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Fredrike Blokzijl
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | - Bart H M van Straten
- Department of Cardiothoracic Surgery, Catharina Hospital Eindhoven, Eindhoven, Netherlands
| | - Edgar Daeter
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, Netherlands
| | | | - Willem Dieperink
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Iwan C C van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Massimo A Mariani
- Department of Cardiothoracic Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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11
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Bianco V, Kilic A, Gleason TG, Aranda-Michel E, Wang Y, Navid F, Sultan I. Midterm Outcomes for Isolated Coronary Artery Bypass Grafting in Octogenarians. Ann Thorac Surg 2020; 109:1184-1193. [DOI: 10.1016/j.athoracsur.2019.07.096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/07/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022]
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12
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Schaal NK, Assmann A, Rosendahl J, Mayer-Berger W, Icks A, Ullrich S, Lichtenberg A, Akhyari P, Heil M, Ennker J, Albert A. Health-related quality of life after heart surgery - Identification of high-risk patients: A cohort study. Int J Surg 2020; 76:171-177. [PMID: 32169572 DOI: 10.1016/j.ijsu.2020.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/31/2020] [Accepted: 02/28/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This cohort study evaluated factors, which have been shown to be relevant for Health-Related Quality of Live (HRQL) after cardiac surgery and investigated the combinatory impact on HRQL. Additionally, the aim was to introduce a first attempt to developing a risk estimation model which could identify patients at risk for impaired HRQL. METHODS For this single-centre cohort study, 6099 cardiac surgical patients (60% isolated coronary bypass surgery) filled in the Nottingham Health Profile (NHP) for the evaluation of HRQL six months after surgery and provided information regarding their medical and socio-demographic status. For the NHP scores the deviation to the matched normative data of a healthy sample was calculated. A robust linear regression examined factors that influence HRQL. As a next step, based on the regression model, a risk estimation model was developed which is a first attempt to classify patients into risk categories. RESULTS Male gender, age below 60 or between 60 and 74 years, living alone, no occupation, bypass surgery, NYHA status II, III or IV and chest pain were identified as risk factors to determine impaired HRQL. The model explains 29.13% of the variance. Based on the risk estimation model 27.4% were classified as medium or high risk. CONCLUSIONS For the first time a multilevel method was applied to evaluate HRQL after heart surgery showing that socio-demographic variables are important co-factors to dyspnea and chest pain. We take a first attempt in developing a new approach that should encourage further research in this field to frame a screening tool that may help identifying patients at risk in the future.
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Affiliation(s)
- Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Alexander Assmann
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Jenny Rosendahl
- Institute of Psychosocial Medicine and Psychotherapy, Jena University Hospital, Jena, Germany
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Heinrich-Heine-University, Düsseldorf, Germany
| | | | - Artur Lichtenberg
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Payam Akhyari
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany
| | - Martin Heil
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jürgen Ennker
- Department of Cardiac Surgery, HELIOS Klinik, Krefeld, Germany; University of Witten-Herdecke, Witten, Germany
| | - Alexander Albert
- Department of Cardiovascular Surgery, University Clinic, Düsseldorf, Germany; Department of Cardiovascular Surgery Klinikum Dortmund GGmbH, Dortmund, Germany
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13
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El-Ansary D, LaPier TK, Adams J, Gach R, Triano S, Katijjahbe MA, Hirschhorn AD, Mungovan SF, Lotshaw A, Cahalin LP. An Evidence-Based Perspective on Movement and Activity Following Median Sternotomy. Phys Ther 2019; 99:1587-1601. [PMID: 31504913 DOI: 10.1093/ptj/pzz126] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/07/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023]
Abstract
Cardiac surgery via median sternotomy is performed in over 1 million patients per year worldwide. Despite evidence, sternal precautions in the form of restricted arm and trunk activity are routinely prescribed to patients following surgery to prevent sternal complications. Sternal precautions may exacerbate loss of independence and prevent patients from returning home directly after hospital discharge. In addition, immobility and deconditioning associated with restricting physical activity potentially contribute to the negative sequelae of median sternotomy on patient symptoms, physical and psychosocial function, and quality of life. Interpreting the clinical impact of sternal precautions is challenging due to inconsistent definitions and applications globally. Following median sternotomy, typical guidelines involve limiting arm movement during loaded lifting, pushing, and pulling for 6 to 8 weeks. This perspective paper proposes that there is robust evidence to support early implementation of upper body activity and exercise in patients recovering from median sternotomy while minimizing risk of complications. A clinical paradigm shift is encouraged, one that encourages a greater amount of controlled upper body activity, albeit modified in some situations, and less restrictive sternal precautions. Early screening for sternal complication risk factors and instability followed by individualized progressive functional activity and upper body therapeutic exercise is likely to promote optimal and timely patient recovery. Substantial research documenting current clinical practice of sternal precautions, early physical therapy, and cardiac rehabilitation provides support and the context for understanding why a less restrictive and more active plan of care is warranted and recommended for patients following a median sternotomy.
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Affiliation(s)
- Doa El-Ansary
- Department of Health Professions, Faculty of Art, Health and Design, Swinburne University of Technology, Melbourne, Victoria, Australia; Department of Surgery, School of Medicine, University of Melbourne, Melbourne, Australia; and Clinical Research Institute, Sydney, Australia. Address all correspondence to Associate Professor El-Ansary at:
| | - Tanya Kinney LaPier
- Department of Physical Therapy, Eastern Washington University, Spokane, Washington. Dr LaPier is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Jenny Adams
- Baylor Institute for Rehabilitation, Baylor University Medical Center, Dallas, Texas
| | - Richard Gach
- Department of Rehabilitation Services, Memorial Regional Hospital, Hollywood, Florida
| | - Susan Triano
- Department of Rehabilitation Services, Memorial Regional Hospital, Hollywood, Florida
| | - Md Ali Katijjahbe
- Department of Health Professions, Faculty of Art, Health and Design, Swinburne University of Technology Department of Physiotherapy, Hospital Canselor Tuanku Muhriz, UKM Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Andrew D Hirschhorn
- MQ Health Physiotherapy and Department of Health Professions, Faculty of Medicine and Health, Macquarie University, Sydney, Australia
| | - Sean F Mungovan
- Department of Health Professions, Faculty of Art, Health and Design, Swinburne University of Technology, Clinical Research Institute and Westmead Private Physiotherapy Services, Westmead Private Hospital, Sydney, Australia
| | - Ana Lotshaw
- Baylor Institute for Rehabilitation, Baylor University Medical Center. Dr Lotshaw is a board-certified clinical specialist in cardiovascular and pulmonary physical therapy
| | - Lawrence P Cahalin
- Department of Physical Therapy, Miller School of Medicine, University of Miami, Coral Gables, Florida
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14
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Coelho PNMP, Miranda LMRPC, Barros PMP, Fragata JIG. Quality of life after elective cardiac surgery in elderly patients. Interact Cardiovasc Thorac Surg 2019; 28:199-205. [PMID: 30085061 DOI: 10.1093/icvts/ivy235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Cardiac surgery has little effect on life expectancy in elderly patients. Thus, improving the quality of life should be the main factor affecting therapeutic decisions. Most studies on quality of life in elderly patients undergoing cardiac surgery report improvement but have limitations. Consequently, we assessed improvements in the quality of life of elderly patients undergoing elective cardiac surgery, identified influencing variables and established patterns of mental and physical health variations in the first year postoperatively. METHODS We conducted a prospective study of patients aged 65 or older who underwent elective cardiac surgery between September 2011 and August 2013. The 36-item Short Form (SF-36) surveys were obtained preoperatively and at 3, 6 and 12 months postoperatively. RESULTS The 430 preoperative patients with a mean age of 74 years (SD 5.5 years) comprised 220 men. Most physical health improvements occurred within 3 months and continued to improve significantly until 12 months. Predictive variables for patients showing less improvement were poor preoperative physical health, female sex, older age and longer length of hospital stay. Mental health improved significantly through the third postoperative month. The negative predictive variables were poor preoperative mental health and longer intensive care unit stay. CONCLUSIONS Most patients improved both physically and mentally after surgery, and most of the improvement occurred within 3 months post-surgery. These improvement patterns should be taken into account when creating rehabilitation programmes, and patients should be counselled on what improvements can be expected during the first 12 months after surgery.
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Affiliation(s)
- Pedro N M P Coelho
- Department of Cardiothoracic Surgery, Hospital Santa Marta, Lisbon, Portugal.,Universidade Nova de Lisboa, Lisbon, Portugal
| | | | | | - José I G Fragata
- Department of Cardiothoracic Surgery, Hospital Santa Marta, Lisbon, Portugal.,Universidade Nova de Lisboa, Lisbon, Portugal
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15
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Lee SO, Lee H, Cho YH, Jeong DS, Lee YT, Kim WS. Comparison of Off-Pump Coronary Artery Bypass between Octogenarians and Septuagenarians: A Propensity Score Analysis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:155-161. [PMID: 31236375 PMCID: PMC6559184 DOI: 10.5090/kjtcs.2019.52.3.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022]
Abstract
Background Coronary artery bypass grafting (CABG) is being offered increasingly frequently to octogenarians. However, old age is known to be an independent risk factor in CABG. The aim of this study was to compare the outcomes of off-pump coronary artery bypass (OPCAB) between octogenarians and septuagenarians. Methods We retrospectively reviewed the data of 1,289 consecutive patients aged ≥70 years who underwent OPCAB at a single institution between 2001 and 2016. We compared the outcomes of 115 octogenarians and 1,174 septuagenarians. Using propensity score matching, based on preoperative clinical characteristics, 114 octogenarians were matched with 338 septuagenarians. Results Propensity score analysis revealed that the incidence of acute kidney injury (14.9% vs. 7.9%, p=0.028) and respiratory complications (8.8% vs. 4.2%, p=0.040) was significantly higher in octogenarians. The early mortality rate (2.6% vs. 1.0%, p=0.240) and 1-year survival rate (89.5% vs. 94.4%, p=0.097) were not statistically significant between the groups. However, the 5-year survival rate (67.3% vs. 79.9%, p<0.001) was significantly lower in octogenarians. Previous myocardial infarction and a left ventricular ejection fraction ≤35% were associated with a poor 1-year survival rate. Conclusion Early and 1-year outcomes of OPCAB in octogenarians were tolerable when compared with those in septuagenarians. OPCAB could be a suitable option for octogenarians.
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Affiliation(s)
- Sang On Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heemoon Lee
- Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Perrotti A, Ecarnot F, Monaco F, Dorigo E, Monteleone P, Besch G, Chocron S. Quality of life 10 years after cardiac surgery in adults: a long-term follow-up study. Health Qual Life Outcomes 2019; 17:88. [PMID: 31118026 PMCID: PMC6532216 DOI: 10.1186/s12955-019-1160-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 05/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background Quality of life (QoL) is a multifactorial concept that assesses physical and mental health. We prospectively studied the quality of life of patients undergoing coronary artery bypass graft (CABG) surgery using the Short-Form 36-item questionnaire (SF-36) up to 10 years after surgery. Methods Between January 2000 and December 2002, all patients undergoing elective isolated CABG in the cardiac & thoracic surgery department of a large university hospital in Eastern France underwent initial QoL evaluation with the SF-36. The same questionnaire was mailed to every patient annually (± 2 weeks around the date of surgery) up to 10 years after their operation. We recorded socio-demographic and clinical variables at inclusion. Predictors of impaired QoL at 10 years were identified by logistic regression. Results A total of 272 patients (213 men, 59 women) were enrolled; mean age at inclusion was 65 ± 10 years. At 10 years post-surgery, 81 patients had died (29.7%). The physical component summary (PCS) score was significantly higher at 5 years after surgery than at baseline (p < 0.01), and significantly lower at 10 years than at 5 years (p < 0.01), although there remained a significant difference between 10-year PCS and baseline score (p = 0.004). The mental component summary (MCS) score was significantly higher at 5 years than at the time of surgery (p < 0.001), and remained significantly higher compared to baseline at 10 years after surgery (p = 0.010). By multivariate analysis, diabetes and dypsnea were both associated with worse PCS at 10 years, while lower age was associated with better 10-year PCS. Only diabetes was associated with impaired MCS at 10 years. Conclusions Cardiac surgery appears to durably and positively affect both physical and mental components of quality of life. Electronic supplementary material The online version of this article (10.1186/s12955-019-1160-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrea Perrotti
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,EA 3920, University of Franche-Comté, 25000, Besançon, France
| | - Fiona Ecarnot
- EA 3920, University of Franche-Comté, 25000, Besançon, France. .,Department of Cardiology, University Hospital Jean Minjoz, 3, Boulevard Fleming, 25000, Besançon, France.
| | - Francesco Monaco
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,Department of Mental Health, Residential Eating Disorder Unit "Mariconda", ASL Salerno, Salerno, Italy
| | - Enrica Dorigo
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Guillaume Besch
- EA 3920, University of Franche-Comté, 25000, Besançon, France.,Department of Anesthesiology and Surgical Intensive Care Unit, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France
| | - Sidney Chocron
- Cardio-Thoracic Surgery Department, University Hospital Jean Minjoz, Boulevard Fleming, 25000, Besançon, France.,EA 3920, University of Franche-Comté, 25000, Besançon, France
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Shan L, Saxena A, Goh D, Robinson D. A systematic review on the quality of life and functional status after abdominal aortic aneurysm repair in elderly patients with an average age older than 75 years. J Vasc Surg 2019; 69:1268-1281. [DOI: 10.1016/j.jvs.2018.09.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Accepted: 09/04/2018] [Indexed: 10/27/2022]
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18
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Gjeilo KH, Stenseth R, Wahba A, Lydersen S, Klepstad P. Long-term health-related quality of life and survival after cardiac surgery: A prospective study. J Thorac Cardiovasc Surg 2018; 156:2183-2190.e2. [DOI: 10.1016/j.jtcvs.2018.05.087] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 05/04/2018] [Accepted: 05/12/2018] [Indexed: 01/14/2023]
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19
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Fibronectin promotes elastin deposition, elasticity and mechanical strength in cellularised collagen-based scaffolds. Biomaterials 2018; 180:130-142. [PMID: 30036726 DOI: 10.1016/j.biomaterials.2018.07.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 12/21/2022]
Abstract
One of the tightest bottlenecks in vascular tissue engineering (vTE) is the lack of strength and elasticity of engineered vascular wall models caused by limited elastic fiber deposition. In this study, flat and tubular collagen gel-based scaffolds were cellularised with vascular smooth muscle cells (SMCs) and supplemented with human plasma fibronectin (FN), a known master organizer of several extracellular matrix (ECM) fiber systems. The consequences of FN on construct maturation was investigated in terms of geometrical contraction, viscoelastic mechanical properties and deposition of core elastic fiber proteins. FN was retained in the constructs and promoted deposition of elastin by SMCs as well as of several proteins required for elastogenesis such as fibrillin-1, lysyl oxidase, fibulin-4 and latent TGF-β binding protein-4. Notably, gel contraction, tensile equilibrium elastic modulus and elasticity were strongly improved in tubular engineered tissues, approaching the behaviour of native arteries. In conclusion, this study demonstrates that FN exerts pivotal roles in directing SMC-mediated remodeling of scaffolds toward the production of a physiological-like, elastin-containing ECM with excellent mechanical properties. The developed FN-supplemented systems are promising for tissue engineering applications where the generation of mature elastic tissue is desired and represent valuable advanced in vitro models to investigate elastogenesis.
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Gao J, Wang HB, Xiao JY, Ren M, Reilly KH, Li YM, Liu Y. Association between proprotein convertase subtilisin/kexin type 9 and late saphenous vein graft disease after coronary artery bypass grafting: a cross-sectional study. BMJ Open 2018; 8:e021951. [PMID: 29991632 PMCID: PMC6089317 DOI: 10.1136/bmjopen-2018-021951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The study aims to explore the association between serum proprotein convertase subtilisin/kexin type 9 (PCSK9) level and saphenous vein grafts disease (SVGD) after coronary artery bypass grafting (CABG). DESIGN A cross-sectional study. SETTING A secondary hospital in Tianjin City, China. PARTICIPANTS A total of 231 participants were included in the study. Inclusion criteria were as follows: age ≥18 years, previous CABG surgery at least 12 months ago, at least one SVG for bypass during CABG, abnormal non-invasive test results or recurrent stable angina pectoris by coronary angiography indications, and willing to participate and sign informed consent. Participants with any of the following were excluded from the study: congenital valvular disease, decompensated heart failure, anaemia defined as a haemoglobin level of <12 g/dL in women or <13 g/dL in men, malignant neoplasms, renal failure, severe hepatic disease, thyroid disease, acute or chronic inflammatory disease and chronic obstructive lung disease. PRIMARY OUTCOME MEASURE SVGD was defined as at least one SVG with significant stenosis (≥50%). Circulating PCSK9 levels were measured using commercial ELISA kits according to the manufacturer's instructions. RESULTS The mean PCSK9 level in the SVGD group was significantly higher than that in the patent group (275.2±38.6 vs 249.3±37.7, p<0.01). The multivariate logistic regression model revealed a significant association between serum PCSK9 and SVGD (OR 2.08, 95% CI 1.46-2.95) per 1 SD increase in serum PCSK9. CONCLUSIONS The present study is the first to identify an independent association between PCSK9 and late SVGD after adjustment for established cardiovascular risk factors. A multicentre prospective cohort study with large sample size should be conducted in the future to further research this relationship.
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Affiliation(s)
- Jing Gao
- Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | - Hai-Bo Wang
- Peking University Clinical Research Institute, Beijing, China
| | - Jian-yong Xiao
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Min Ren
- Cardiovascular Institute, Tianjin Chest Hospital, Tianjin, China
| | | | - Yu-Ming Li
- Logistics University of Chinese People’s Armed Police Forces, Tianjin, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
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21
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Nanayakkara S, Marwick TH, Kaye DM. The ageing heart: the systemic and coronary circulation. Heart 2017; 104:370-376. [PMID: 29092917 DOI: 10.1136/heartjnl-2017-312114] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/22/2022] Open
Abstract
Most cardiovascular disease (CVD) occurs in patients over the age of 60. However, most evidence-based current cardiovascular guidelines lack evidence in an older population, due to the under-representation of older patients in randomised trials. Blood pressure rises with age due to increasing arterial stiffness, and stricter control results in improved outcomes. Myocardial ischaemia is also more common with increasing age, due to a combination of coronary artery disease and myocardial changes. However, despite higher rates of adverse outcomes, older patients are offered guideline-based therapy less frequently. Frailty is an independent predictor of mortality in adults over the age of 60, yet remains poorly assessed; slow gait speed is a key marker for the development of frailty and for adverse outcomes following intervention. Few trials have assessed frailty independent of age; however, there is evidence that non-frail older patients derive significant benefit from therapy, highlighting the urgent need to include frailty as a measure in clinical trials of treatment in CVD.In this review, the authors appraise the literature in regard to the cardiovascular changes with ageing, specifically in relation to the systemic and coronary circulation and with a particular emphasis on frailty and its implication in the evaluation and treatment of CVD.
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Affiliation(s)
- Shane Nanayakkara
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Thomas H Marwick
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - David M Kaye
- Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.,Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Chen Y, Ding S, Tao X, Feng X, Lu S, Shen Y, Wu Y, An X. The quality of life of patients developed delirium after coronary artery bypass grafting is determined by cognitive function after discharge: A cross-sectional study. Int J Nurs Pract 2017; 23. [PMID: 28752905 DOI: 10.1111/ijn.12563] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 03/21/2017] [Accepted: 04/30/2017] [Indexed: 12/14/2022]
Abstract
AIMS Postoperative delirium (POD) and declined cognitive function were common in patients (especially elderly patients) who underwent coronary artery bypass grafting (CABG), which may affect quality of life (QoL). The aim of this study was to determine the relationships among age, POD, declined cognitive function, and QoL in patients who underwent CABG. METHODS Consecutive patients who underwent first time elective CABG and assessed for POD using Confusion Assessment Method for intensive care unit for 5 postoperative days from November 2013 to March 2015 were recruited. A cross-sectional study was conducted during April 2015 to assess their cognitive function and QoL, using the Telephone Interview for Cognitive Status Scale and Medical Outcomes Study 36-Item Short Form Health Survey. The relationships among age, POD, declined cognitive function, and QoL were tested using path analysis. RESULTS Declined cognitive function was associated with poorer QoL. POD was associated with declined cognitive function but was not associated with poorer QoL. Ageing was not associated with QoL but was associated with POD and declined cognitive function. CONCLUSION The QoL of patients developed delirium after CABG is determined by cognitive function after discharge. Necessary strategies should be implemented to prevent POD and declined cognitive function, especially in elderly patients.
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Affiliation(s)
- Yuling Chen
- School of Nursing, Capital Medical University, Beijing, China
| | - Shu Ding
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangjun Tao
- School of Nursing, Capital Medical University, Beijing, China
| | - Xinwei Feng
- School of Nursing, Capital Medical University, Beijing, China
| | - Sai Lu
- School of Nursing and Midwifery College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Yuzhi Shen
- Department of Heart Center, Beijing Chao-Yang Hospital, Beijing, China
| | - Ying Wu
- School of Nursing, Capital Medical University, Beijing, China
| | - Xiangguang An
- Department of Heart Center, Beijing Chao-Yang Hospital, Beijing, China
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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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Dąbek J, Pyka E, Piotrkowicz J, Stachoń K, Bonek-Wytrych G. Impact of post-hospital cardiac rehabilitation on the quality of life of patients after surgical treatment for coronary artery disease. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2017; 14:120-126. [PMID: 28747944 PMCID: PMC5519838 DOI: 10.5114/kitp.2017.68743] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 06/05/2017] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The quality of life of cardiovascular patients is worse than that of healthy individuals. Pain, dyspnea, and fatigue impair daily activities, which in turn leads to decreased life satisfaction and emotional deterioration. The objective of comprehensive treatment, including early rehabilitation, is to reduce the risk of complications, progression, and recurrence of the disease, as well as to restore, maintain, or improve all aspects of the patient's quality of life to the greatest extent possible. AIM To assess the quality of life of patients who underwent surgical treatment for coronary artery disease and completed the second phase of cardiac rehabilitation. MATERIAL AND METHODS The study enrolled 100 patients undergoing early cardiac rehabilitation in stationary conditions after coronary artery bypass grafting. The group included 21 women and 79 men; their age ranged from 40 to 75 years. The study employed a questionnaire of our own design. RESULTS Post-hospital cardiac rehabilitation resulted in quality of life improvements, especially with regard to psychological aspects, reducing the occurrence of anxiety from 44% to 21%. In addition, the rehabilitation program reduced the occurrence of subjective ailments such as chest pain (from 68% to 10%), fatigue (from 40% to 33%), and dyspnea (from 50% to 12%). CONCLUSIONS Despite the achievement of quality of life improvements among patients after surgery coronary artery by-pass grafting and early cardiac rehabilitation, the result is not fully satisfactory. Systematic treatment and education should be continued to further improve the health of patients.
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Affiliation(s)
- Józefa Dąbek
- School of Health Science in Katowice, Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Ewelina Pyka
- School of Health Science in Katowice, Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Joanna Piotrkowicz
- School of Health Science in Katowice, Department of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Krystian Stachoń
- Department of Anesthesiology and Intensive Care with Cardiac Monitoring, Independent Public Clinical Hospital No. 7, Upper Silesian Medical Center, Medical University of Silesia, Katowice, Poland
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Pezzoli D, Cauli E, Chevallier P, Farè S, Mantovani D. Biomimetic coating of cross-linked gelatin to improve mechanical and biological properties of electrospun PET: A promising approach for small caliber vascular graft applications. J Biomed Mater Res A 2017; 105:2405-2415. [DOI: 10.1002/jbm.a.36098] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 04/03/2017] [Accepted: 04/26/2017] [Indexed: 12/13/2022]
Affiliation(s)
- Daniele Pezzoli
- Laboratory for Biomaterials and Bioengineering; CRC-I, Department of Mining, Metallurgical and Materials Engineering and CHU de Quebec Research Centre, Laval University; Quebec City QC G1L 3L5 Canada
| | - Elisa Cauli
- Department of Chemistry; Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano; Milan 20133 Italy
| | - Pascale Chevallier
- Laboratory for Biomaterials and Bioengineering; CRC-I, Department of Mining, Metallurgical and Materials Engineering and CHU de Quebec Research Centre, Laval University; Quebec City QC G1L 3L5 Canada
| | - Silvia Farè
- Laboratory for Biomaterials and Bioengineering; CRC-I, Department of Mining, Metallurgical and Materials Engineering and CHU de Quebec Research Centre, Laval University; Quebec City QC G1L 3L5 Canada
- Local Unit Politecnico di Milano; INSTM, Consorzio Nazionale di Scienza e Tecnologia dei Materiali; Milan Italy
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering; CRC-I, Department of Mining, Metallurgical and Materials Engineering and CHU de Quebec Research Centre, Laval University; Quebec City QC G1L 3L5 Canada
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Impact of marital status and comorbid disorders on health-related quality of life after cardiac surgery. Qual Life Res 2017; 26:2421-2434. [PMID: 28484915 DOI: 10.1007/s11136-017-1589-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE To explore associations between HRQL, marital status, and comorbid disorders in men and women following cardiac surgery. METHOD A secondary analysis was completed using data from a randomized controlled trial in which 416 individuals (23% women) scheduled for elective coronary artery bypass graft and/or valve surgery were recruited between March 2012 and September 2013. HRQL was assessed using the Health State Descriptive System (15D) preoperatively, then at 2 weeks, and at 3, 6, and 12 months following cardiac surgery. Linear mixed model analyses were performed to explore associations between HRQL, social support, and comorbid disorders. RESULTS The overall 15D scores for the total sample improved significantly from 2 weeks to 3 months post surgery, with only a gradual change observed from 3 to 12 months. Thirty percent (n = 92) of the total sample reported a lower 15D total score at 12 months compared to preoperative status, of whom 78% (n = 71) had a negative minimum important differences (MID), indicating a worse HRQL status. When adjusted for age and marital status, women had statistically significant lower 15D total scores compared to men at 3, 6, and 12 months post surgery. Compared to pre-surgery, improvement was demonstrated in 4 out of 15 dimensions of HRQL for women, and in 6 out of 15 dimensions for men at 12 months post surgery. Both men and women associated back/neck problems, depression, and persistent pain intensity with lower HRQL; for women, not living with a partner/spouse was associated with lower HRQL up to 12 months. CONCLUSION Women experienced decreased HRQL and a slower first-year recovery following cardiac surgery compared to men. This study demonstrates a need for follow-up and support to help women manage their symptoms and improve their function within the first year after cardiac surgery. This was particularly pronounced for those women living alone.
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Sakthong P, Kasemsup V, Winit-Watjana W. Assessment of health-related quality of life in Thai patients after heart surgery. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0902.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Little is known about health-related quality of life (HRQoL) of Thai patients after heart surgery. The Thai government initiated a cardiac surgery project to celebrate the 80th birthday anniversary of His Majesty The King.
Objectives
To evaluate the HRQoL of Thai patients after heart surgery, as part of the Thai government’s cardiac surgery project, and to investigate the association of HRQoL instruments and patient characteristics.
Methods
Of 7,863 patients in the project, 386 were randomly selected for a telephone interview by trained researchers during June–November 2008. The HRQoL of Thai patients was measured using 12-item Short Form version 2 and EuroQoL (EQ-5D) plus an EQ-5D visual analog scale (EQ-VAS).
Results
The mean age of patient participants was 50.4 ± 13.7 years (range 17–82) and 49.5% were male. The Physical Component Summary (PCS) and Mental Component Summary (MCS) scores were reported as 46.91 and 54.44, respectively, compared with the US norm scores of 50. The EQ-5D and EQ-VAS utility scores of 0.81 and 0.84 were comparable to those of Thai general population (0.77–0.84), but higher than those of Thai patients with heart disease (0.73–0.75). Patients with older age, female sex, unemployment, and presence of comorbidity rated a lower HRQoL. The multiple linear regression models showed that both EQ-5D and EQ-VAS were associated with PCS and MCS and could be predicted by 40%–50%.
Conclusion
Overall, the HRQoL of patients after the heart surgery was satisfactory. The QoL in patients with a specific types of heart surgery warrants further study.
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Affiliation(s)
- Phantipa Sakthong
- Department of Pharmacy Practice , Faculty of Pharmaceutical Sciences , Chulalongkorn University , Bangkok 10330 , Thailand
| | - Vijj Kasemsup
- Department of Community Medicine , Ramathibodi Hospital , Mahidol University , Bangkok 10400 , Thailand
| | - Win Winit-Watjana
- Department of Allied Health , College of Health Sciences , University of Bahrain , Manama , Bahrain
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O'Neill DE, Knudtson ML, Kieser TM, Graham MM. Considerations in Cardiac Revascularization for the Elderly Patient: Age Isn't Everything. Can J Cardiol 2016; 32:1132-9. [DOI: 10.1016/j.cjca.2016.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 02/04/2023] Open
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Thorsteinsson K, Andreasen JJ, Mortensen RN, Kragholm K, Torp-Pedersen C, Gislason G, Køber L, Fonager K. Longevity and admission to nursing home according to age after isolated coronary artery bypass surgery: a nationwide cohort study. Interact Cardiovasc Thorac Surg 2016; 22:792-8. [PMID: 26969738 DOI: 10.1093/icvts/ivw045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 01/26/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Data on nursing home admission in patient's ≥80 years after isolated coronary artery bypass grafting (CABG) are scarce. The purpose of this study was to evaluate longevity and subsequent admission to a nursing home stratified by age in a nationwide CABG cohort. METHODS All patients who underwent isolated CABG from 1996 to 2012 in Denmark were identified through nationwide registers. The cumulative incidence of admission to a nursing home after CABG was estimated. A Cox regression model was constructed to identify predictors for living in a nursing home 1 year after CABG. Kaplan-Meier estimates were used for survival analysis. Subanalysis on home care usage was performed in the period 2008-2012. RESULTS A total of 38 487 patients were included. The median age was 65.4 ± 9.5 years (1455 > 80 years) and 80% were males. The 30-day mortality rate was 2.8%, increasing with age (1.2% in patients <60 years and 7.8% in patients ≥80 years). The mortality rate at 1 year was 2.2% among patients aged <60 and 14.1% among patients ≥80 years. At the 1-year follow-up, 4.2% of patients <60 years, 7.9% of patients 60-70 years, 14.4% of patients 70-74 years, 18.5% of patients 75-79 years and 29.1% of patients ≥80 years had received home care. The proportion of patients admitted to a nursing home at 1, 5 and 10 years after CABG was 0.1, 0.4 and 1.0% (<60 years), and 1.4, 7.5 and 16.8% (≥80 years), respectively. Main predictors for living in a nursing home 1 year postoperatively were: age ≥80 years [hazard ratio (HR) 17.8, 95% confidence interval (CI) 7.4-42.8], female sex (HR 1.7, 95% CI 1.1-2.6), previous heart failure (HR 1.6, 95% CI 1.0-2.4), previous myocardial infarction (HR 2.0, 95% CI 1.3-3.2) and previous stroke (HR 3.3, 95% CI 2.1-4.9). Neither urgent nor emergency surgeries were significant predictors for living in a nursing home 1 year postoperatively. CONCLUSIONS The majority of all patients selected for CABG surgery in Denmark between 1996-2012, including the elderly, were able to live independently at home without the need of home care for many years after CABG. The risk of nursing home admission was small and dependent on the patient's age, sex and preoperative comorbidities.
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Affiliation(s)
- Kristinn Thorsteinsson
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan J Andreasen
- Department of Cardiothoracic Surgery, Aalborg University Hospital, Aalborg, Denmark Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Rikke N Mortensen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark
| | - Kristian Kragholm
- Department of Anesthesiology and Intensive Care Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Epidemiology, Aalborg University Hospital, Aalborg, Denmark Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark The Danish Heart Foundation, Copenhagen, Denmark The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kirsten Fonager
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark Department of Social Medicine, Aalborg University Hospital, Aalborg, Denmark
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Abstract
A proportion of elderly with coronary artery disease is rapidly growing. They have more severe coronary artery disease, therefore, derive more benefit from revascularization and have a greater need for it. The elderly is a heterogeneous group, but compared to the younger cohort, the choice of the optimal revascularization method is much more complicated among them. In recent decades, results has improved dramatically both in surgery and percutaneous coronary intervention (PCI), even in very old persons. Despite the lack of evidence in elderly, it is obvious, that coronary artery bypass surgery (CABG) has a more pronounced effect on long-term survival in price of more strokes, while PCI is certainly less invasive. Age itself is not a criterion for the selection of treatment strategy, but the elderly are often more interested in quality of life and personal independence instead of longevity. This article discusses the factors that influence the choice of the revascularization method in the elderly with stable angina and presents a complex algorithm for making an individual risk-benefit profile. As a consequence the features of CABG and PCI in elderly patients are exposed. Emphasis is centered on the frailty and non-medical factors, including psychosocial, as essential components in making the decision of what strategy to choose. Good communication with the patients and giving them unbiased information is encouraged.
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Peric V, Jovanovic-Markovic S, Peric D, Rasic D, Novakovic T, Dejanovic B, Borzanovic M. Quality of Life in Patients of Different Age Groups before and after Coronary Artery By-Pass Surgery. Ann Thorac Cardiovasc Surg 2015; 21:474-80. [PMID: 26328597 DOI: 10.5761/atcs.oa.15-00041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The study evaluates the changes in quality of life (QOL) six months after coronary artery bypass grafting (CABG) related to the patients' age. METHODS The total of 243 consecutive patients completed the Nottingham Health Profile Questionnaire part 1 before and six months after CABG. Postoperative questionnaire was completed by 226 patients. Patients were divided into four examined groups (<50, 50-59, 60-69 and ≥70 years), according to their age. RESULTS Six months after CABG, the quality of life in different sections has been significantly improved in most patients.The analysis of the relation between the age and the changes in QOL of patients six months after CABG showed a significant correlation among the patients' age and the improvement of QOL in the sections of physical mobility (r = 0.18, p = 0.008), social isolation (r = 0.17, p = 0.01) and energy ( r = 0.21, p = 0.002). The most prominent improvement was found in older patients. The age was not an independent predictor of QOL deterioration after CABG. CONCLUSIONS The most noticeable improvement of QOL six months after CABG was found in older patients. Age is not the independent predictor of deterioration of QOL after CABG.
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Affiliation(s)
- Vladan Peric
- University of Pristina, School of Medicine, Kosovska Mitrovica, Serbia
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Lemaignen A, Birgand G, Ghodhbane W, Alkhoder S, Lolom I, Belorgey S, Lescure FX, Armand-Lefevre L, Raffoul R, Dilly MP, Nataf P, Lucet J. Sternal wound infection after cardiac surgery: incidence and risk factors according to clinical presentation. Clin Microbiol Infect 2015; 21:674.e11-8. [DOI: 10.1016/j.cmi.2015.03.025] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/13/2015] [Accepted: 03/31/2015] [Indexed: 11/28/2022]
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Østergaard B, Holbæk E, Sørensen J, Steinbrüchel D. Health-related quality of life after off-pump compared with on-pump coronary bypass grafting among elderly high-risk patients: A randomized trial with eight years of follow-up. Eur J Cardiovasc Nurs 2015; 15:126-33. [DOI: 10.1177/1474515115571041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 01/08/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Birte Østergaard
- Research Unit of Nursing, Clinical Institute, University of Southern, Denmark
| | - Elisabeth Holbæk
- Department of Cardiothoracic Surgery, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jan Sørensen
- Centre for Applied Health Services Research, University of Southern, Denmark
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The evolution of cardiovascular surgery in elderly patient: a review of current options and outcomes. BIOMED RESEARCH INTERNATIONAL 2014; 2014:736298. [PMID: 24812629 PMCID: PMC4000933 DOI: 10.1155/2014/736298] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/25/2014] [Indexed: 01/22/2023]
Abstract
Due to the increase in average life expectancy and the higher incidence of cardiovascular disease with advancing age, more elderly patients present for cardiac surgery nowadays. Advances in pre- and postoperative care have led to the possibility that an increasing number of elderly patients can be operated on safely and with a satisfactory outcome. Currently, coronary artery bypass surgery, aortic and mitral valve surgery, and major surgery of the aorta are performed in elderly patients. The data available show that most cardiac surgical procedures can be performed in elderly patients with a satisfactory outcome. Nevertheless, the risk for these patients is only acceptable in the absence of comorbidities. In particular, renal dysfunction, cerebrovascular disease, and poor clinical state are associated with a worse outcome in elderly patients. Careful patient selection, flawless surgery, meticulous hemostasis, perfect anesthesia, and adequate myocardial protection are basic requirements for the success of cardiac surgery in elderly patients. The care of elderly cardiac surgical patients can be improved only through the strict collaboration of geriatricians, anesthesiologists, cardiologists, and cardiac surgeons, in order to obtain a tailored treatment for each individual patient.
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