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

Saha, Shekhar; Varghese, Sam; Ahmad, A. Al; Jebran, Ahmad Fawad; Waezi, N.; Niehaus, Heidi; Baraki, Hassina; Kutschka, Ingo

doi:10.1055/s-0038-1670663

Cited by 8 publications

(8 citation statements)

References 38 publications

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“…Immunosenescence and multiple comorbidities render older patients susceptible to IE [15,16]. Furthermore, major factors that determine postoperative outcome are the disease-independent influence of the biological aging process and, therefore, the cellular and tissue aging process, in addition to the presence of comorbidities such as advanced atherosclerosis, impaired diastolic heart function, renal insufficiency, reduced lung compliance, and respiratory muscle strength [17,18]. Nutritional and functional status have also been found to be independent predictors of mortality in older patients suffering from IE [15].…”

Section: Discussionmentioning

confidence: 99%

“…Nutritional and functional status have also been found to be independent predictors of mortality in older patients suffering from IE [15]. Complex valve surgery, even in the setting of reoperation in older patients, has been reported to be feasible with good outcomes [18,19]. Although cardiac surgery in elderly patients has been reported to be associated with an improvement in HRQOL, a decline in HRQOL has been reported in about 8-19% of patients [20].…”

Section: Discussionmentioning

confidence: 99%

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Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis

Saha

Mladenova

Radner

et al. 2022

JCM

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Objectives: The objective of this study was to compare the long-term outcomes and health-related quality of life (HRQOL) of patients following surgery for infective native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). Methods: We retrospectively identified 633 consecutive patients who had undergone surgery for infective endocarditis at our center between January 2005 and October 2018. The patients were interviewed, and the SF-36 survey was used to assess the HRQOL of survivors. Propensity score matching (2:1) was performed with data from a German reference population. Multivariable analysis incorporated binary logistic regression using a forward stepwise (conditional) model. Results: The median age of the cohort was 67 (55–74) years, and 75.6% were male. Operative mortality was 13.7% in the NVE group and 21.6% in the PVE group (p = 0.010). The overall survival at 1 year was 88.0% and was comparable between the groups. The physical health summary scores were 49 (40–55) for the NVE patients and 45 (37–52) for the PVE patients (p = 0.043). The median mental health summary scores were 52 (35–57) and 49 (41–56), respectively (p = 0.961). On comparison of the HRQOL to the reference population, the physical health summary scores were comparable. However, significant differences were observed with regard to the mental health summary scores (p = 0.005). Conclusions: Our study shows that there are significant differences in the various domains of HRQOL, not only between NVE and PVE patients, but also in comparison to healthy individuals. In addition to preoperative health status, it is important to consider the patient’s expectations regarding surgery. Further prospective studies are required.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis

Saha

Mladenova

Radner

et al. 2022

JCM

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“…In our cohort, patients suffering from TIE were significantly older than those suffering from SAVR–PVE, and this is not surprising. Although advanced age is associated with higher risk of death, longer hospital stay, and neurologic complications, it is dependent on the patients’ comorbidities, level of dependence, and nutritional and cognitive status; therefore, age itself should not be a contraindication to complex valve surgery [ 24 , 25 ]. Furthermore, we found that a significantly higher proportion of the patients in the TIE-group were immunosuppressed on chronic steroid therapy, which has been identified as a risk factor for TIE [ 20 ].…”

Section: Commentmentioning

confidence: 99%

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Saha

Ali

Schnackenburg

et al. 2022

JCM

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Objectives: As surgical experience with infective endocarditis following transcatheter aortic valve replacement is scarce, this study compared the perioperative and short-term outcomes of patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement. Methods: Between January 2013 and December 2020, 468 consecutive patients were admitted to our center for surgery for IE. Among them, 98 were operated on for endocarditis following surgical aortic valve replacement and 22 for endocarditis following transcatheter aortic valve replacement. Results: The median EuroSCORE II (52.1 (40.6–62.0) v/s 45.4 (32.6–58.1), p = 0.207) and STS-PROM (1.8 (1.6–2.1) v/s 1.9 (1.4–2.2), p = 0.622) were comparable. Endocarditis following transcatheter aortic valve replacement accounted for 13.7% of the aortic prosthetic valve endocarditis between 2013 and 2015; this increased to 26.9% in the years 2019 and 2020. Concomitant procedures were performed in 35 patients (29.2%). The operative mortality was 26.5% in the endocarditis following surgical aortic valve replacement group and 9.1% in the endocarditis following transcatheter aortic valve replacement group (p = 0.098). Upon follow-up, survival at 6 months was found to be 98% in the group with endocarditis following surgical aortic valve replacement and 89% in the group with endocarditis following transcatheter aortic valve replacement (p = 0.081). Conclusions: Patients suffering from endocarditis following surgical aortic valve replacement and transcatheter aortic valve replacement present with comparable risk profiles and can be surgically treated with comparable results. Surgery as a curative option should not be rejected even in this intermediate-risk cohort.

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“…This trend is also reflected in the surgical population, where the care for older persons (although often challenging) has become quite common [ 5 ]. Old age is related with a decline in physiological reserve [ 6 , 7 ] and most of these patients will present themselves with more risk factors than their younger counterparts [ 8 ]. Although advantages in prehabilitation, operative techniques and perioperative management seem to improve outcome and quality of life in octogenarians, postoperative adverse events remain more common in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery

Tjeertes,

Simoncelli,

van den Enden

et al. 2024

Aging Clin Exp Res

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Background Decision-making whether older patients benefit from surgery can be a difficult task. This report investigates characteristics and outcomes of a large cohort of inpatients, aged 80 years and over, undergoing non-cardiac surgery. Methods This observational study was performed at a tertiary university medical centre in the Netherlands. Patients of 80 years or older undergoing elective or urgent surgery from January 2004 to June 2017 were included. Outcomes were length of stay, discharge destination, 30-day and long-term mortality. Patients were divided into low-, intermediate and high-risk surgery subgroups. Univariable and multivariable logistic regression were used to evaluate the association of risk factors and outcomes. Secondary outcomes were time trends, assessed with Mantel–Haenszel chi-square test. Results Data of 8251 patients, undergoing 19,027 surgical interventions were collected from the patients’ medical record. 7032 primary procedures were suitable for analyses. Median LOS was 3 days in the low-risk group, compared to six in the intermediate- and ten in the high-risk group. Median LOS of the total cohort decreased from 5.8 days (IQR 1.9–14.5) in 2004–2007 to 4.6 days (IQR 1.9–9.0) in 2016–2017. Three quarters of patients were discharged to their home. Postoperative 30-day mortality in the low-risk group was 2.3%. In the overall population 30-day mortality was high and constant during the study period (6.7%, ranging from 4.2 to 8.4%). Conclusion Patients should not be withheld surgery solely based on their age. However, even for low-risk surgery, the mortality rate of more than 2% is substantial. Deciding whether older patients benefit from surgery should be based on the understanding of individual risks, patients’ wishes and a patient-centred plan.

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

Cited by 8 publications

References 38 publications

Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis

Health-Related Quality of Life following Surgery for Native and Prosthetic Valve Infective Endocarditis

Surgery for Aortic Prosthetic Valve Endocarditis in the Transcatheter Era

Perioperative outcome, long-term mortality and time trends in elderly patients undergoing low-, intermediate- or major non-cardiac surgery

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