Morbimortalidade em octogenários submetidos à cirurgia de revascularização miocárdica

Júnior, Fernando Pivatto; Kalil, Renato A. K.; Costa, Altamiro Reis da; Pereira, Edemar; Santos, Eduardo Z.; Valle, Felipe Homem; Bender, Luciano; Trombka, Marcelo; Modkovski, Thaís B.; Nesralla, Ivo A.

doi:10.1590/s0066-782x2010005000071

Cited by 6 publications

(2 citation statements)

References 15 publications

(20 reference statements)

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“…As a consequence of older patient referral for cardiac surgery, cardiac pathology is often more considerable. Indeed, we found 36.3% of octogenarians received combined cardiac procedures (predominantly AVR and CABG), which is among the highest rates compared to previous studies [ 10 ]-[ 12 ] and associated with longer CPB and aortic cross clamp time. It is not surprising that octogenarians with more complex procedures have higher risk for major post-operative complications and consequently greater health service utilization (i.e.…”

Section: Discussionmentioning

confidence: 61%

“…Operating on this specific demographic is not only a challenge to cardiac surgeons but also a challenge to cardiologists, anesthesiologists, CVICU intensivists, and the whole medical system [ 11 ]. Previous studies have shown that the in-hospital mortality in octogenarians undergoing isolated CABG, AVR and MVR were 6.8%-14.3% [ 5 ],[ 12 ]-[ 14 ], 4.5%-12.6% [ 6 ],[ 15 ]-[ 17 ], and 2.7%-18.5% [ 7 ],[ 18 ], respectively. In a multi-center retrospective study gathering data from 22 high volume cardiac centers in the United States, the reported in-hospital mortality rates for octogenarians after cardiac surgery were 8.1% for isolated CABG, 10.1% for combined CABG and AVR, and 19.6% for combined CABG and MVR [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

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Association between older age and outcome after cardiac surgery: a population-based cohort study

Wang

Bagshaw

Norris

et al. 2014

J Cardiothorac Surg

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ObjectiveOctogenarians (aged ≥ 80 years) are increasingly being referred for cardiac surgery. We aimed to describe the morbidity, mortality, and health services utilization of octogenarians undergoing elective cardiac surgery.MethodsRetrospective population-based cohort study of adult patients receiving elective cardiac surgery between January 1 2004 and December 31 2009. Primary exposure was age ≥80 years. Outcomes were 30-day, 1- and 5-year mortality, post-operative complications, and ICU/hospital lengths of stay. Multi-variable logistic and Cox regression analyses were used to explore the association between older age and outcome.ResultsOf 6,843 patients receiving cardiac surgery, 544 (7.9%) were octogenarians. There was an increasing trend in the proportion of octogenarians undergoing surgery during the study period (0.3% per year, P = 0.073). Octogenarians were more likely to have combined procedures (valve plus coronary artery bypass or multiple valves) compared with younger strata (p < 0.001). Crude 30-day, 1-year and 5-year mortality for octogenarians were 3.7%, 10.8% and 29.0%, respectively. Compared to younger strata, octogenarians had higher adjusted 30-day (OR 4.83, 95%CI 1.30-17.92; P = 0.018) and 1-year mortality (OR 4.92; 95% CI, 2.32-10.46. P<0.001). Post-operative complications were more likely among octogenarians. Octogenarians had longer post-operative stays in ICU and hospital, and higher rates of ICU readmission (P < 0.001 for all). After multi-variable adjustment, age ≧ 80 years was an independent predictor of death at 30-days and 1 year.ConclusionsOctogenarians are increasingly referred for elective cardiac surgery with more combined procedures. Compared to younger patients, octogenarians have a higher risk of post-operative complications, consume greater resources, and have worse but acceptable short and long-term survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s13019-014-0177-6) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Association between older age and outcome after cardiac surgery: a population-based cohort study

Wang

Bagshaw

Norris

et al. 2014

J Cardiothorac Surg

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The effect of Ulinastatin on postoperative course in cardiopulmonary bypass patients in Asia: a meta-analysis of randomized controlled trials

Qiaoli

Chen

et al. 2022

J Cardiothorac Surg

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Objectives To evaluate the effect of urinary trypsin inhibitor (UTI) or Ulinastatin on postoperative course and clinical outcomes in patients with cardiopulmonary bypass. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library for the keywords UTI and Cardiopulmonary bypass (CPB). The primary outcome measure was the intensive care unit length of stay (ICU LOS), and results were stratified for relevant subgroups (dosage of UTI). The effects of UTI on mechanical ventilation duration (MVD), hospital LOS, renal failure incidence (RFI), and all-cause mortality were studied as secondary outcomes. Results Twelve randomized controlled trials (enrolling 1620 patients) were evaluated. Eleven studies pooled for subgroup analysis showed that using UTI persistently or with a considerable amount would lead to a shorter ICU LOS (95% CI, − 0.69 to − 0.06; P = 0.0001). Ten studies showed that UTI could shorten MVD in patients (95% CI, − 1.505 to − 0.473; P < 0.0001). RFI generally showed a more favourable outcome with UTI treatment (95%CI, 0.18–1.17; P = 0.10). And the current evidence was insufficient to prove that UTI could reduce the hospital LOS (95% CI, − 0.22 to 0.16; P = 0.75) and the all-cause mortality rate (95% CI, 0.24–2.30; P = 0.60). Conclusions Various subsets of UTI treatment suggested that UTI could shorten ICU LOS, and it is associated with the dosage of UTI. Considering the substantial heterogeneity and lack of criteria for UTI dosage, more evidence is needed to establish a standard dosing guideline.

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Sobrevida em longo prazo de octogenários submetidos à cirurgia de revascularização miocárdica isolada

Júnior¹,

Valle²,

Pereira³

et al. 2011

Rev Bras Cir Cardiovasc

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Morbimortalidade em octogenários submetidos à cirurgia de revascularização miocárdica

Abstract: Background: Given the progressive increase in longevity and the need of an increasingly elderly population to undergo myocardial revascularization surgery (MRS), it becomes necessary to know its risks and benefits.

Cited by 6 publications

References 15 publications

Association between older age and outcome after cardiac surgery: a population-based cohort study

Association between older age and outcome after cardiac surgery: a population-based cohort study

The effect of Ulinastatin on postoperative course in cardiopulmonary bypass patients in Asia: a meta-analysis of randomized controlled trials

Sobrevida em longo prazo de octogenários submetidos à cirurgia de revascularização miocárdica isolada

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