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Velho TR, Gonçalves J, Maniés Pereira R, Ferreira R, Sena A, Junqueira N, Ângelo E, Carvalho Guerra N, Mendes M, Arruda Pereira R, Nobre Â. Surgical aortic valve replacement in octogenarians: Single-center perioperative outcomes and five-year survival. Rev Port Cardiol 2024; 43:311-320. [PMID: 38401703 DOI: 10.1016/j.repc.2024.02.003] [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: 09/24/2023] [Revised: 11/23/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). METHODS A retrospective observational single-center cohort study with 195 patients aged ≥80 years old, who underwent SAVR between 2017 and 2021, was conducted. Patients were divided into two groups according to EuroscoreII: (1) Low risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Continuous variables are presented in median (IQR), analyzed using Wilcoxon rank sum test; categorical variables in percentages, analyzed using chi-squared test; and survival was analyzed by Kaplan-Meier, open cohort, and the log-rank test was performed. RESULTS The overall median age was 82 (IQR 81-83), with 4.6% of the patients ≥85 years old. 23.6% of the patients presented EuroscoreII ≥4%. No complications were observed in 26.2%, with a significantly higher rate in intermediate-high risk patients. Postoperative need for hemodynamic support was the most frequent complication, followed by postoperative acute kidney injury and the use of blood products. Overall median ICU stay was three days (2-4) and hospital length of stay (LOS) six days (5-8). Patients with intermediate-high risk and those with complications had longer ICU LOS. At 12 months, overall survival was 96.4%, at three years 94.1% and 5 years 75.4%. Patients with low surgical risk had higher survival proportions up to 5 years. CONCLUSION SAVR in patients ≥80 years is associated with low in-hospital mortality, although a significant proportion of patients develop complications. Long-term follow-up up to five years after surgery is acceptable in octogenarians with low surgical risk.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal.
| | - João Gonçalves
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Rafael Maniés Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - André Sena
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Nádia Junqueira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Eurídice Ângelo
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Mário Mendes
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ricardo Arruda Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
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Helms F, Rümke S, Schill B, Kühn C. Case report: Blood pressure variation during cardiopulmonary bypass in a patient with multiple sclerosis. Ann Med Surg (Lond) 2024; 86:1700-1703. [PMID: 38463045 PMCID: PMC10923366 DOI: 10.1097/ms9.0000000000001716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/03/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Multiple sclerosis is known to be associated with both sympathetic and parasympathetic cardiovascular autonomic dysregulation. Thus, patients with multiple sclerosis comorbidity represent a potentially challenging patient population in cardiac surgery, especially in on-pump operations. Despite this, very little is known about the hemodynamics during cardiopulmonary bypass and the optimal perfusion strategy for patients with multiple sclerosis undergoing cardiac operations. Case presentation In this report, the authors describe a patient with relapsing-remitting multiple sclerosis, who underwent successful triple valve operation for aortic and mitral stenosis and tricuspid valve insufficiency. Distinct blood pressure variations in form of temporary pressure dips were noted during total cardiopulmonary bypass time as well as during the reperfusion period. Clinical discussion Pressure variations were not attributable to surgical, pharmacological or perfusion-related manoeuvres. Thus, they most likely represent symptoms of cardiovascular autonomic dysregulation manifesting during cardiopulmonary bypass. In this patient, blood pressure variations terminated spontaneously and remained within an acceptable range without external correction. Conclusions When treating patients with multiple sclerosis comorbidity, the potential pressure variability due to cardiovascular autonomic dysregulation should be taken into consideration to avoid increased blood pressure volatility due to overcorrection or undercorrection during cardiopulmonary bypass.
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Affiliation(s)
- Florian Helms
- Division for Cardiothoracic, Transplantation and Vascular Surgery
| | - Stefan Rümke
- Division for Cardiothoracic, Transplantation and Vascular Surgery
| | - Bettina Schill
- Department of Anesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Christian Kühn
- Division for Cardiothoracic, Transplantation and Vascular Surgery
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Pal N, Abrams BA, Kertai M. Cardiothoracic Anesthesiology: Novel Milestone and Renewed Opportunities. Semin Cardiothorac Vasc Anesth 2022; 26:169-172. [DOI: 10.1177/10892532221121115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Nirvik Pal
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA
| | - Benjamin A. Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Miklos Kertai
- Department of Anesthesiology, Vanderbilt University, Nashville, TN, USA
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