Short-term and long-term results of cardiac surgery in elderly and very elderly patients
| Autor: | Pasquale Caldarola, Claudio Zussa, Khalil Fattouch, Luigi Tavazzi, Donald Cristell, Giampiero Esposito, Sergio Chierchia, Maria Cristina Barattoni, Ernesto Greco, Giuseppe Speziale, Marcio Scorcin, Giuseppe Nasso, Georges Popoff, Alfredo Marchese, Vincenzo Argano, Roberto Coppola |
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| Přispěvatelé: | Speziale, G., Nasso, G., Barattoni, M., Esposito, G., Popoff, G., Argano, V., Greco, E., Scorcin, M., Zussa, C., Cristell, D., Coppola, R., Chierchia, S., Marchese, A., Caldarola, P., Fattouch, K., Tavazzi, L. |
| Rok vydání: | 2011 |
| Předmět: |
Male
Time Factors medicine.medical_treatment Kaplan-Meier Estimate law.invention AMI Valve replacement law Retrospective Studie Risk Factors Thoracic aorta Cardiac Surgical Procedure Duke Activity Status Index Age Factor Myocardial infarction Hospital Mortality CABG Aged 80 and over Age Factors Canadian Cardiovascular Society cardiopulmonary bypa Cardiac surgery Survival Rate GVM Treatment Outcome Italy Elective Surgical Procedures cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine Human Pulmonary and Respiratory Medicine medicine.medical_specialty Logistic Model Time Factor acute myocardial infarction Risk Assessment coronary artery bypass graft Internal medicine medicine.artery New York Heart Association medicine Cardiopulmonary bypass Humans Cardiac Surgical Procedures Survival rate Aged Proportional Hazards Models Retrospective Studies Elective Surgical Procedure business.industry Risk Factor Patient Selection CPB Retrospective cohort study Settore MED/23 - Chirurgia Cardiaca medicine.disease DASI CCS Surgery Logistic Models Proportional Hazards Model NYHA business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 141(3):725-731.e1 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2010.05.010 |
| Popis: | Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright © 2011 by The American Association for Thoracic Surgery. |
| Databáze: | OpenAIRE |
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