Cardiac surgery in 260 octogenarians: a case series

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• 作者：Anna Mara Scandroglio (1)
  Gabriele Finco (2)
  Marina Pieri (1)
  Roberto Ascari (1)
  Maria Grazia Calabrò (1)
  Daiana Taddeo (1)
  Francesca Isella (1)
  Annalisa Franco (1)
  Mario Musu (2)
  Giovanni Landoni (1) (4)
  Ottavio Alfieri (3) (4)
  Alberto Zangrillo (1) (4)
  
  1. Department of Anesthesia and Intensive Care ; IRCCS San Raffaele Scientific Institute ; Via Olgettina 60 ; 20132 ; Milan ; Italy
  2. Department of Medical Sciences “M. Aresu- Cagliari University ; Cagliari ; Italy
  4. Vita-Salute San Raffaele University ; Milan ; Italy
  3. Department of Cardiac Surgery ; IRCCS San Raffaele Scientific Institute ; Milan ; Italy
  
• 关键词：Octogenarian ; Cardiac surgery ; Mortality ; Complications ; Anesthesia ; Intensive care
• 刊名：BMC Anesthesiology
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：15
• 期：1
• 参考文献：1. Oskvig RM: Special problems in the elderly. / Chest 1999, 115:158S-64. 10.1378/chest.115.suppl_2.158S CrossRef
  2. Geokas MC, Lakatta EG, Makinodan T, Timiras PS: The aging process. / Ann Intern Med 1990, 113:455-6. 10.7326/0003-4819-113-6-455 CrossRef
  3. Wk F, Schaff HV, O’Brian PC, Orszulak TA, Naessens JM, Tajik AJ: Cardiac outcome in the octogenarian: perioperative outcome and clinical follow-up. / J Am Coll Cardiol 1991,18(1):29-5. 10.1016/S0735-1097(10)80212-8 CrossRef
  4. Edmunds LH, Stephenson LW, Edie RN, Ratcliffe MB: Open-heart surgery in octogenarians. / N Engl J Med 1988, 319:131-. 10.1056/NEJM198807213190302 CrossRef
  5. Song HK, Diggs BS, Slater MS, Guyton SW, Ungerleider RM, Welke KF: Improved quality and cost-effectiveness of coronary artery bypass grafting in the United States from 1988-005. / J Thorac Cardiovasc Surg 2009, 137:65-. 10.1016/j.jtcvs.2008.09.053 CrossRef
  6. Thygesen K, Alpert JS, White HD, on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the Redefition of Myocardial Infarction: Universal definition of myocardial infarction. / Circulation 2007, 116:2634-3. 10.1161/CIRCULATIONAHA.107.187397 CrossRef
  7. Prondzinsky R, Unverzagt S, Russ M, Lemm H, Swyter M, Wegener N, / et al.: Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. / Shock 2012,37(4):378-4. doi:10.1097/SHK.0b013e31824a67af 10.1097/SHK.0b013e31824a67af CrossRef
  8. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup: Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. / Crit Care 2004,8(4):R204-2. 10.1186/cc2872 CrossRef
  9. Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. / Nephron 1976, 16:31-1. 10.1159/000180580 CrossRef
  10. Ranucci M, Castelvecchio S, Conte M, Megliola G, Speziale G, Fiore F, / et al.: The easier, the better: age, creatinine, ejection fraction score for operative mortality risk stratification in a series of 29,659 patients undergoing elective cardiac surgery. / J Thorac Cardiovasc Surg 2011,142(3):581-. doi:10.1016/j.jtcvs.2010.11.064 10.1016/j.jtcvs.2010.11.064 CrossRef
  11. Update to the Society of Thoracic Surgeons and the Society of Cardiovascular Anesthesiologists Blood Conservation Clinical Practice Guidelines 2011.http://www.sts.org/sites/default/files/documents/pdf/guidelines/BloodConservationUpdate0311.pdf
  12.
• 刊物主题：Anesthesiology; Internal Medicine; Emergency Medicine; Intensive / Critical Care Medicine;
• 出版者：BioMed Central
• ISSN：1471-2253

文摘

Background The elderly undergo cardiac surgery more and more frequently, often present multiple comorbidities, assume chronic therapies, and present a unique physiology. Aim of our study was to analyze the experience of a referral cardiac surgery center with all types of cardiac surgery interventions performed in patients ?0?years old over a six years-period. Methods A retrospective observational study performed in a university hospital. 260 patients were included in the study (3.5% of the patients undergoing cardiac surgery in the study period). Results Mean age was 82?±-.8?years. Eighty-five percent of patients underwent elective surgery, 15% unplanned surgery and 4.2% redo surgery. Intervention for aortic valve pathology and coronary artery bypass grafting were performed in 51% and 46% of the patients, respectively. Interventions involving the mitral valve were the 26% of the total, those on the tricuspid valve were 13% and those on the ascending aortic arch the 9.6%. Postoperative low output syndrome was identified in 44 patients (17%). Mortality was 3.9% and most of the patients (91%) were discharged from hospital in good clinical conditions. Hospital mortality was lower in planned vs unplanned surgery: 3.8% vs 14% respectively. Chronic obstructive pulmonary disease (OR 9.106, CI 2.275 -36.450) was the unique independent predictor of mortality. Conclusions Clinicians should be aware that cardiac surgery can be safely performed at all ages, that risk stratification is mandatory and that hemodynamic treatment to avoid complications is expected.