Aortic valve replacement with or without myocardial revascularization in octogenarians. Can minimally invasive extracorporeal circuits improve the outcome?
| Autor: | Benjamin Haupt, Aschraf El-Essawi, Wolfgang Harringer, Rene M.H.J. Brouwer, Mohammed Morjan, Ingo Breitenbach |
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| Přispěvatelé: | University of Zurich, El-Essawi, Aschraf |
| Rok vydání: | 2018 |
| Předmět: |
Male
Cardiac output medicine.medical_specialty 2902 Advanced and Specialized Nursing 610 Medicine & health 030204 cardiovascular system & hematology 2705 Cardiology and Cardiovascular Medicine Extracorporeal law.invention 3311 Safety Research 03 medical and health sciences 0302 clinical medicine Aortic valve replacement law Internal medicine Myocardial Revascularization Cardiopulmonary bypass 2741 Radiology Nuclear Medicine and Imaging Humans Minimally Invasive Surgical Procedures Medicine Radiology Nuclear Medicine and imaging Coronary Artery Bypass Propensity Score Aged Retrospective Studies Aged 80 and over Heart Valve Prosthesis Implantation Advanced and Specialized Nursing business.industry Equipment Design General Medicine aortic valve replacement cardiopulmonary Bypass coronary artery bypass grafting minimally invasive extracorporeal circuits octogenarians medicine.disease Intensive care unit 10020 Clinic for Cardiac Surgery Treatment Outcome medicine.anatomical_structure 030228 respiratory system Aortic Valve Heart Valve Prosthesis Concomitant Propensity score matching Cardiology Female Cardiology and Cardiovascular Medicine business Safety Research Artery |
| Zdroj: | Perfusion. 34:217-224 |
| ISSN: | 1477-111X 0267-6591 |
| DOI: | 10.1177/0267659118811048 |
| Popis: | Objective: The positive impact of minimally invasive extracorporeal circuits (MiECC) on patient outcome is expected to be most evident in patients with limited physiologic reserves. Nevertheless, most studies have limited their use to low-risk patients undergoing myocardial revascularization. As such, there is little evidence to their benefit outside this patient population. We, therefore, set out to explore their potential benefit in octogenarians undergoing aortic valve replacement (AVR) with or without concomitant myocardial revascularization. Methods: Based on the type of the utilized ECC, we performed a retrospective propensity score-matched comparison among all octogenarians (n = 218) who received a primary AVR with or without concomitant coronary artery bypass grafting in our institution between 2003 and 2010. Results: A MiECC was utilized in 32% of the patients. The propensity score matching yielded 52 matched pairs. The 30-day postoperative mortality (2% vs. 10%; p=0.2), the incidence of low cardiac output (0% vs. 6%; p=0.2) and the Intensive Care Unit (ICU) stay (2.5 ± 2.6 vs. 3.8 ± 4.7 days; p=0.06) were all in favour of the MiECC group, but failed to reach statistical significance while the 90-day postoperative mortality did (2% vs. 16%; p=0.02). Conclusion: MiECCs have a positive influence on the outcome of octogenarians undergoing AVR with or without concomitant coronary artery bypass grafting. Their use should, therefore, be extended beyond isolated coronary artery bypass graft (CABG) surgery. |
| Databáze: | OpenAIRE |
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