Postoperative complications among octogenarians after cardiovascular surgery

Barnett, Scott D.; Halpin, Linda; Speir, Alan M.; Albus, Robert A.; Akl, Bechara F.; Massimiano, Paul S.; Burton, Nelson A.; Collazo, Lucas; Lefrak, Edward A.

doi:10.1016/s0003-4975(03)00676-3

Cited by 57 publications

(32 citation statements)

References 9 publications

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“…As older age patients have a relatively poor prognosis after cardiac surgery and a relatively short life expectancy, the surgical indications and strategies for elderly patients are controversial. [9][10][11][12]17,18) Kieser et al considered that use of BITA grafts was not yet shown to be beneficial in patients aged >70 years. 9) On the other hand, Medalion et al and Kinoshita et al reported that use of BITA grafts improved late survival and freedom from cardiac events in patients aged >65 years and >70 years, respectively.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Hashimoto

Fukui

Takanashi

2015

ATCS

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Purpose: The feasibility of using bilateral internal thoracic artery (BITA) grafts for coronary artery bypass grafting (CABG) in octogenarians is not clear. This study aimed to compare outcomes between use of BITA and single internal thoracic artery (SITA) grafts in octogenarians undergoing isolated CABG. Methods: Isolated CABG was performed in 1,566 patients at the Sakakibara Heart Institute between September 2004 and December 2012. Of these, 125 consecutive octogenarians were included and divided into two groups, according to the use of BITA grafts (101 subjects) or SITA grafts (24 subjects). Early and late outcomes were compared between groups. Results: The preoperative patient characteristics were similar between the two groups. Early outcomes were similar, including hospital death or deep sternal infection. The estimated 5-year survival rate was similar in the BITA and SITA groups (78% vs 62%, p = 0.269). Freedom from major adverse cardiac or cerebrovascular events was significantly higher in the BITA group than in the SITA group after 5 years (90% vs 75%, p = 0.032). Conclusions: Our results suggest that use of BITA grafts for CABG is feasible and beneficial in octogenarians, resulting in improved late outcomes without increased operative risk.

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Section: Discussionmentioning

confidence: 99%

Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Hashimoto

Fukui

Takanashi

2015

ATCS

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“…Considering the relatively high proportion of emergency cases Postoperative complications have been reported in approximately 30% to 40% of cases in septuagenarians [15,16] and more in octogenarians [17,18]. Further, it should be noted that the definition of morbidity or the preoperative comorbid state varies among studies.…”

Section: Dong Jin Kim Et Almentioning

confidence: 99%

Clinical Results of Cardiovascular Surgery in the Patients Older than 75 Years

Kim

Park

Isamukhamedov³

et al. 2014

Korean J Thorac Cardiovasc Surg

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Background:The balance of the risks and the benefits of cardiac surgery in the elderly remains a major concern.We evaluated the early and mid-term clinical results of patients aged over 75 years who underwent major cardiovascular surgery. Methods: Two hundred and fifty-one consecutive patients, who underwent cardiac surgery at Seoul National University Bundang Hospital between July 2003 and June 2011, were included in this study (mean age, 78.7±3.4 years; male:female=130:121). Elective surgery was performed in 112 patients, urgent in 90, and emergency in 49. Results: Early mortality was 12.7% (32/251). Follow-up completion was 100%, and the mean follow-up duration was 2.8±2.2 years. Late mortality was 24.2% (53/219). There were 283 readmissions in a total of 109 patients after discharge. However, the reason for readmission was related more to non-cardiac factors (71.3%) than to cardiac factors. The overall survival estimates were 79.2% at the 1-year follow-up and 58.4% at the 5-year follow-up. Patients who underwent elective surgery had a lower early mortality rate (elective, 4.5%; urgent, 13.3%; emergency, 30.6%) and better overall survival rate than those that underwent urgent or emergency surgery (p ＜0.001). Conclusion: The timing of cardiac surgery was found to be an independent risk factor for early and late mortality. Thus, earlier referral and intervention may improve operative results. Further, comprehensive coordinated postoperative care is needed for other comorbid problems in aged patients.

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“…[8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, 15) the efficacy of this newer technique in the elderly remains difficult to verify because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. [16][17][18][19][20][21] Moreover more widespread use of this technique is limited by concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the deFrom the …”

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confidence: 99%

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

Nicolini

Vezzani²,

Romano

et al. 2017

Int. Heart J.

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SummaryAlthough improved long-term outcomes obtained with the use of arterial grafts for coronary revascularization in comparison with the traditional association of a single arterial and saphenous vein grafts have been demonstrated in the overall population, the efficacy of this newer technique in the elderly is difficult to prove because their shorter life expectancy due to advanced heart disease, associated with severe comorbidities. Moreover, more widespread use of this technique is limited by the concerns on the potential morbidity, particularly the longer time required to perform the operation and the possibility of deep sternal wound infection in case of bilateral internal thoracic artery harvesting due to the decreased blood supply to the sternum and surrounding tissues.The review of the recent literature indicates that the use of bilateral internal thoracic arteries in very elderly patients should not be considered routinely. It seems reasonable to avoid it in octogenarians in the presence of well-known predictors of sternal complications such as diabetes, morbid obesity, and severe chronic lung disease.There is also still controversy about the superiority of the radial artery over the saphenous vein graft as a second or third conduit for surgical myocardial revascularization, although the majority of recent studies seem to support more liberal use of the radial artery as second arterial conduit in the elderly. Although a clinical benefit of arterial graft revascularization cannot be formally excluded for elderly patients, the increased complexity of this technique suggests that careful clinical judgment is necessary to select grafts for individual patients.(Int Heart J 2017; 58: 647-653) Key words: Coronary artery disease, Old patients, Arterial grafts N owadays a growing number of patients are older at the time of coronary artery bypass grafting (CABG) and present with a clinical history characterized by more comorbidities than in the past. However, despite the increasing proportions of elderly patients with a worse risk profile for elective CABG, mortality in elderly patients over recent decades has dramatically declined.1) In fact, recent studies on elderly patients operated with CABG reported a 30-day mortality rate ranging between 3.7 and 16.8%, a 1-year mortality between 8% and 10.8% and a 5-year mortality ranging from 28.4% to 31%. 2-6)It is well recognized that octogenarians have a higher risk of post-operative complications, 7) require greater clinical and economic resources, and have worse but acceptable short and long-term survival in comparison with younger patients. However, improvements in technical management, particularly the development of innovative extracorporeal circulatory systems, the use of off-pump CABG and the increased use of pedicled arterial conduits have been proven effective in improving outcomes, although they have not completely eliminated the morbidity in this high-risk population. [8][9][10][11][12][13][14] Although improved long-term outcomes obtained with the use of ...

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Postoperative complications among octogenarians after cardiovascular surgery

Cited by 57 publications

References 9 publications

Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Bilateral Internal Thoracic Artery Grafting: Is It Reasonable in Octogenarians?

Clinical Results of Cardiovascular Surgery in the Patients Older than 75 Years

Coronary Artery Bypass Grafting with Arterial Conduits in the Elderly

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