Open heart surgery in the elderly: results from a consecutive series of 100 patients aged 85 years or older

Rosengart, Todd K.; Finnin, Eileen; Kim, David Y.; Samy, Sanjay; Tanhehco, Yvette C.; Ko, Wilson; Lang, Samuel J.; Krieger, Karl H.; Isom, O. Wayne

doi:10.1016/s0002-9343(01)01097-x

Cited by 19 publications

(7 citation statements)

References 23 publications

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“…Cardiac surgery in elderly patients performed on urgent or emergent basis is associated with a risk of hospital death from 2 to 3 times higher than that of elective surgery patients [15,17]. In our experience the operative mortality rate was 12% similar to all rates of operative mortality in previous studies of patients including octogenarians undergoing cardiac surgery, where mortality ranges from 9% to 20% [3,6]. Moreover in our series all patients were in critical conditions such as unstable angina, acute myocardial infarction in evolution, valve dysfunction and congestive heart failure, shock, ruptured aortic aneurysm or acute aortic dissection.…”

Section: Discussionsupporting

confidence: 76%

“…These predictions are not dissimilar to those effected by the demographics of other European countries and even by U.S. government organizations, according to which, the octogenarians, now amounting to 4.2 million people in the United States of America, will increase to 8.9 trillion in 2030 [2]. As there is an increase of the elderly, cardiac surgery in octogenarian or nonagenarian patients is becoming increasingly common [3][4][5][6]. However, still cardiac surgery in elderly patients is considered high risk and with a reduced expectancy and quality of life after surgery [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Urgent cardiac surgery in octogenarians

et al. 2011

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BACKGROUND: Urgent or emergent cardiac surgery in the elderly is burdened by high operative mortality and unacceptable postoperative quality of life. METHODS: From 1998 to 2007, 251 patients aged 80 years underwent nonelective cardiac surgery for urgent (n = 229) or emergent (n = 22) indications. A logistic regression to identify incremental risk factors for postoperative death was performed. RESULTS: The overall early mortality was of 12%, with 8% in urgent and 45% in emergent cases. The most frequent causes of death were infections, particularly pneumonia (23%), renal failure (20%), CVA (17%), respiratory failure (10%), and multisystem organ failure (10%). Incremental risk factors for early mortality were age, emergent procedure, aortic procedure, cardiopulmonary bypass time, and the presence of a major postoperative complication. Mean follow-up time was 5.4±3.2 years. CONCLUSIONS: An urgent cardiac surgery can be performed in octogenarians with acceptable operative mortality and good long-term survival

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Urgent cardiac surgery in octogenarians

et al. 2011

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“…A total of 81 adult patients undergoing elective open heart surgery with cardiopulmonary bypass (CPB) and aortic cross-clamping (AXCL) consented to be enrolled into the study. Procedures for myocardial protection during the surgery were carried out as previously described [24]. Coronary sinus blood samples were collected twice during surgery: a) 5 minutes after CPB had begun, prior to AXCL; b) within 5 minutes after the end of AXCL.…”

Section: Methodsmentioning

confidence: 99%

MASP-2 activation is involved in ischemia-related necrotic myocardial injury in humans

Zhang

Hou

Çavuşoğlu

et al. 2013

International Journal of Cardiology

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Background/Objectives Insufficient blood supply to the heart results in ischemic injury manifested clinically as myocardial infarction (MI). Following ischemia, inflammation is provoked and related to the clinical outcomes. A recent basic science study indicates that complement factor MASP-2 plays an important role in animal models of ischemia/reperfusion injury. We investigated the role of MASP-2 in human acute myocardial ischemia in two clinical settings: (1) Acute MI, and (2) Open heart surgery. Methods A total of 187 human subjects were enrolled in this study, including 50 healthy individuals, 27 patients who were diagnosed of coronary artery disease (CAD) but without acute MI, 29 patients with acute MI referred for coronary angiography, and 81 cardiac surgery patients with surgically-induced global heart ischemia. Circulating MASP-2 levels were measured by ELISA. Results MASP-2 levels in the peripheral circulation were significantly reduced in MI patients compared with those of healthy individuals or of CAD patients without acute MI. The hypothesis that MASP-2 was activated during acute myocardial ischemia was evaluated in cardiac patients undergoing surgically-induced global heart ischemia. MASP-2 was found to be significantly reduced in the coronary circulation of such patients, and the reduction of MASP-2 levels correlated independently with the increase of the myocardial necrosis marker, cardiac troponin I. Conclusions These results indicate an involvement of MASP-2 in ischemia-related necrotic myocardial injury in humans.

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“…W ITH an aging world population and constantly improving anesthetic and surgical techniques, increasingly more elderly patients are expected to undergo cardiac surgery. [1][2][3] Among sequels that could complicate the postoperative course of cardiac surgery, delirium is one of the most commonly encountered problems. 4 In this respect, advanced age has been identified as an independent predictor for delirium after cardiac surgery, whereas younger age and off-pump surgery were shown to be associated with a lower risk for this complication.…”

mentioning

confidence: 99%

Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly

2012

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Background The aim of this randomized, parallel-arm trial was to study the effect of treating subsyndromal delirium with risperidone on the incidence of clinical delirium in elderly patients who underwent on-pump cardiac surgery. Methods One hundred one patients aged 65 yr or older who experienced subsyndromal delirium after on-pump cardiac surgery were randomized using a computer-generated list to receive 0.5 mg risperidone (n = 51) or placebo (n = 50) every 12 h by mouth. Patients were assessed at 8 h by a blinded observer using the Intensive Care Delirium Screening Checklist, and those scoring more than 3 were evaluated by a blinded psychiatrist to confirm delirium. Patients in either group who experienced delirium were treated according to the same algorithm. Initially, risperidone was administered and if symptoms were not controlled, haloperidol was administered. The primary outcome was the proportion of patients who experienced delirium in either group. Results Seven (13.7%) patients in the risperidone group experienced delirium versus 17 (34%) in the placebo group (P = 0.031) Competing-risks regression analysis showed that failure to treat subsyndromal delirium with risperidone was an independent risk factor for delirium (subhazard ratio, 3.83; 95% CI, 1.63-8.98; P = 0.002). Two (3.9%) patients in the risperidone group experienced extrapyramidal manifestations versus one (2%) in the placebo group (P = 1.0). Conclusion Administration of risperidone to elderly patients who experienced subsyndromal delirium after on-pump cardiac surgery was associated with significantly lower incidence of delirium. Larger studies are required to determine whether early administration of risperidone during the subsyndromal phase of delirium would influence the clinical course of such patients.

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Open heart surgery in the elderly: results from a consecutive series of 100 patients aged 85 years or older

Cited by 19 publications

References 23 publications

Urgent cardiac surgery in octogenarians

Urgent cardiac surgery in octogenarians

MASP-2 activation is involved in ischemia-related necrotic myocardial injury in humans

Early Treatment with Risperidone for Subsyndromal Delirium after On-pump Cardiac Surgery in the Elderly

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