Cardiac reoperations in octogenarians: Do they really benefit?

Abstract

Despite high perioperative mortality, results document a sustainable recovery of the survivors offering the prospect of a highly independent and satisfying life. Therefore, advanced age alone should not be a contraindication for redo cardiac interventions. Geriatr Gerontol Int 2016; 16: 1138-1144.

Outcomes of octogenarians discharged from the hospital after prolonged intensive care unit length of stay after cardiac surgery

“…With recent important reports examining outcomes in the now aging population undergoing cardiac surgery, hospital discharge is frequently cited as the metric to a ''successful'' procedural outcome. 11 However, as demonstrated in this and previous analyses, 12,15,16 survival after a complicated ICU and hospital stay does not necessarily translate to ''thriving'' in the community after hospital discharge. In the current era of cardiac surgery, there is a need to further understand patient-centered outcomes.…”

“…Although recent investigations have sought to understand outcomes in octogenarian patients undergoing cardiac surgery, [9][10][11][12] the long-term functional impact for those patients who require prolonged ICU LOS after cardiac surgery remains unclear. This leads to challenges in decision making on the indication and timing of surgery, in conversations with the patient and their caregivers in times of unanticipated outcomes, and in ensuring adequate discharge planning for these vulnerable patients.…”

Complex Valve Surgery in Elderly Patients: Increasingly Necessary and Surprisingly Feasible

“…11 Cardiac surgery has been shown to bring about improvement in the quality of life and functional status in elderly patients. 3,4,12 However, cardiac surgery in the elderly is challenging for several reasons including advanced atherosclerosis, impaired diastolic heart function, renal failure, reduced lung compliance, and respiratory muscle weakness. 5,6,13,14 Elderly patients are at a higher risk of death, longer hospital stay, and neurologic complications and are more likely to undergo reoperation due to postoperative bleeding.…”

“…1 The increasing proportion of elderly patients poses additional challenges for the clinical management and leads to a higher operative risk due to multiple comorbidities of these patients. 3,4 These include advanced atherosclerosis, impaired diastolic heart function, renal insufficiency, reduced lung compliance, and respiratory muscle strength. Other noteworthy risk factors for surgery in the elderly include agerelated central and peripheral impairment of the nervous system, poor nutritional status, anemia, and altered pharmacokinetics of several drugs.…”

Cardiac Surgery in the Older Adult

“…Although older adults account for half of the cardiac surgeries performed in North America, up to 78% of the major complications and deaths occur in this cohort [14]. Even so, randomized and observational studies continue to demonstrate that older adult patients can receive significant benefits from cardiac surgery, including improvement symptoms, quality of life, prevention of cardiovascular events, and survival [15][16][17][18][19].…”