Purpose: We aimed to evaluate the early outcome of cardiac surgery in patients ≥80 years old and their medium term survival.Methodology: A retrospective study was performed and all patients ≥80 years old that have undergone cardiac surgery between April 2008 and April 2016 at our institute were included. Data for all patients were collected prospectively as part of a national database. A dataset of patient demographics, perioperative data, and survival data were collected.Results: During the study period, a total of 2,627 patients underwent cardiac surgery, of which, 279 patients were ≥80 years old. Six patients (2.2%) were ≥90 years. Average age was 83 ± 2 years and 66% were males. Isolated CABG (34%) followed by combined AVR and CABG (24%) were the commonest operations performed. Redo cardiac surgery was performed in 7% of patients. The median time of mechanical ventilation was 13 h (IQR: 9 h) and the median ICU stay was 24 h (IQR: 27 h). The median length of hospital stay was 8 days. Cerebrovascular accident occurred in 5 patients (1.8%) and 7 patients (2.5%) required renal replacement therapy. The overall early mortality was 2.9% (1.0% for isolated CABG and 5.1% for isolated AVR). Multivariate analysis confirmed new renal failure as an independent risk factor for early mortality (p < 0.001). Kaplan-Meier analysis estimated the mean survival of 5.7 years (95%CI: 5.1-6.2) after operation. The 8-year survival was 43%. Multivariate analyses showed new renal failure (p = 0.001) and stroke (p = 0.024) as independent risk factors for medium-term mortality.Conclusion: Cardiac surgery can be safely performed in carefully selected octogenarians with acceptable early morbidity and mortality as well as reasonable medium-term survival.
Functional paragangliomas are rare neuroendocrine tumours that secrete
catecholamines and are infrequently found in the mediastinum. We report a case
of a young male with symptoms of catecholamine excess and a personal and family
history of the paraganglioma predisposing succinate dehydrogenase subunit B
mutation. The lesion had anatomical intrapericardial juxtaposition to important
cardiac anatomy and posed the significant challenge of dissection at surgery.
The lesion was successfully resected via sternotomy on cardiopulmonary bypass
and confirmed histopathologically as paraganglioma. Intrapericardial
paraganglioma is rare and treatment is difficult and time critical considering
the proximity of cardiac anatomy as well as malignant potential.
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