The changing face of cardiac surgery patients: an insight into a Mediterranean region

Pierri, Michele D.; Capestro, Filippo; Zingaro, Carlo; Torracca, Lucia

doi:10.1016/j.ejcts.2010.02.040

Cited by 43 publications

(31 citation statements)

References 20 publications

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“…This is the first systematic study in Europe on such a large population operated by one cardiac surgeon in one academic cardiac surgery centre, which has confirmed the trend of [9][10][11][12]. However, we found unique data that enhance the differences between the general population and CAD surgical patients.…”

Section: Discussionsupporting

confidence: 78%

Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

et al. 2015

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Section: Discussionsupporting

confidence: 78%

Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

et al. 2015

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“…Patients aged ≥75 years at the time of operation increased from 17% in 1999 to 29% in 2005 (90). Operated patients had more comorbidities, with increased rates of hypertension (from 43.7% in 1999 to 68.9% in 2007), obesity (from 13% to 17.5% in the same period) and worse functional and cardiac status (reduced ejection fraction, hemodynamic instability and shock) (90). Improvement in anesthetics, surgical and perioperative treatments allows surgeons to accept patients for operation, who, only a few years ago, would have been refused.…”

Section: Clinical Evidence For Ricmentioning

confidence: 99%

Remote Ischemic Conditioning

Heusch

Bøtker

Przyklenk

et al. 2015

Journal of the American College of Cardiology

555

531

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In remote ischemic conditioning (RIC) brief, reversible episodes of ischemia with reperfusion in one vascular bed, tissue or organ confer a global protective phenotype and render remote tissues and organs resistant to ischemia/reperfusion injury. The peripheral stimulus can be chemical, mechanical or electrical and involves activation of peripheral sensory nerves. The signal transfer to the heart or other organs is through neuronal and humoral communications. Protection can be transferred, even across species, with plasma-derived dialysate and involves nitric oxide, stromal derived factor-1α, microRNA-144, but also other, not yet identified factors. Intracardiac signal transduction involves: adenosine, bradykinin, cytokines, and chemokines, which activate specific receptors; intracellular kinases; and mitochondrial function. RIC by repeated brief inflation/deflation of a blood pressure cuff protects against endothelial dysfunction and myocardial injury in percutaneous coronary interventions, coronary artery bypass grafting and reperfused acute myocardial infarction. RIC is safe and effective, noninvasive, easily feasible and inexpensive.

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“…2 In addition, patients with an acute ST-elevation myocardial infarction, patients with renal insufficiency, those with cerebrovascular disease, and women appear to have better outcomes with OPCAB than with conventional CABG. With a rising elderly cardiac surgical population, 3 outcomes in patients with advanced age need critical evaluation. Several series have documented cardiac surgical outcomes among elderly patients with varying results.…”

mentioning

confidence: 99%

“…Several series have documented cardiac surgical outcomes among elderly patients with varying results. 3–6 It is unknown whether elderly patients undergoing isolated CABG operations derive any benefit when performed off-pump.…”

mentioning

confidence: 99%

Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?

LaPar

Bhamidipati

Reece

et al. 2011

The Journal of Thoracic and Cardiovascular Surgery

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Objective Selected patients appear to benefit from off-pump coronary artery bypass compared with conventional coronary artery bypass with cardiopulmonary bypass. It is unknown whether elderly patients undergoing isolated coronary artery bypass grafting operations derive any benefit when performed off-pump. We hypothesized that off-pump coronary bypass offers a greater operative benefit to elderly patients when compared with conventional coronary artery bypass. Methods A total of 1993 elderly patients (age ≥80 years) underwent isolated, primary coronary artery bypass graft operations at 16 different statewide centers from 2003 to 2008. Patients were stratified into 2 groups: conventional coronary artery bypass (n = 1589, age = 82.5 ± 2.4 years) and off-pump bypass (n = 404, age = 83.0 ± 2.4 years). Preoperative risk, intraoperative findings, postoperative complications, and costs were evaluated. Results Patients undergoing off-pump bypass grafting were marginally older (P = .001) and had higher rates of preoperative atrial fibrillation (14.6%vs 10.0%; P = .01) and New York Heart Association class IV heart failure (29.7% vs 21.1%; P <.001) than did those having conventional coronary bypass grafting. Other patient risk factors and operative variables, including Society of Thoracic Surgeons predicted risk of mortality, were similar in both groups (P = .15). Compared with off-pump bypass, conventional coronary bypass incurred higher blood transfusion rates (2.0 ± 1.7 units vs 1.6 ± 1.9 units; P = .05) as well as more postoperative atrial fibrillation (28.4% vs 21.5%; P = .003), prolonged ventilation (14.7% vs 11.4%; P = .05), and major complications (20.1% vs 15.6%; P = .04). Importantly, postoperative stroke (2.6% vs 1.7%; P = .21), renal failure (8.1% vs 6.2%; P = .12), and postoperative length of stay (P = .41) were no different between groups. Despite more complications in patients having conventional bypass, operative mortality (P = .53) and hospital costs (P = .43) were similar to those of patients having off-pump procedures. Conclusions Performance of coronary artery bypass grafting among octogenarian patients is safe and effective. Off-pump coronary artery bypass confers shorter postoperative ventilation but equivalent mortality to conventional coronary artery bypass. Off-pump coronary artery bypass was associated with a reduction in the composite incidence of major complications in unadjusted and adjusted analyses and should be considered an acceptable alternative to conventional bypass for myocardial revascularization in elderly patients.

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The changing face of cardiac surgery patients: an insight into a Mediterranean region

Abstract: These changes can reflect both a variation in the characteristics of the population and a major evolution in intervention cardiology and also impose more intensive and extensive postoperative treatment and less invasive cardiac surgery practice.

Cited by 43 publications

References 20 publications

Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

Change in the clinical profile of patients referred for coronary artery bypass grafting from 2004 to 2008. Trends in a single-centre study

Remote Ischemic Conditioning

Is off-pump coronary artery bypass grafting superior to conventional bypass in octogenarians?

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