Cardiac surgery in octogenarians; peri-operative outcome and long-term results.
TLDR
Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay, and long-term survival and quality of life are good.Abstract:
Aims Because the elderly are increasingly referred for operation, we reviewed the results of cardiac surgery in patients of 80 years or older.
Methods and Results Records of 182 consecutive octogenarians who had had cardiac operations between 1992 and 1998 were reviewed. Follow-up was 100% complete. Seventy patients had coronary grafting (CABG), 70 aortic valve replacement, 30 aortic valve replacement+CABG, and 12 mitral valve repair/replacement. Rates of hospital death, stroke, and prolonged stay (>14 days) were as follows: CABG: 7 (10%), 2 (2·8%) and 41 (58%); aortic valve replacement: 6 (8·5%), 2 (2·8%) and 32 (45·7%); aortic valve replacement+CABG: 8 (26·5%), 1 (3·8%) and 14 (46·6%); mitral valve repair/replacement: 3 (25%), 1 (8·3%) and 5 (41·6%). Multivariate predictors ( P <0·05) of hospital death were New York Heart Association functional class, urgent procedure, prolonged cardiopulmonary bypass time, and, after aortic valve replacement, previous percutaneous aortic valvuloplasty. Ascending aortic atheromatous disease was predictive of stroke, while pre-operative myocardial infarction was predictive of prolonged hospital stay. Actuarial 5-year survival was as follows: CABG, 65·8±8·8%; aortic valve replacement, 63·6±7·1%; aortic valve replacement+CABG, 62·4±6·8%; mitral valve repair/replacement, 57·1±5·6%; and total, 63·0±5·6%. Multivariate predictors of late death were pre-operative myocardial infarction, and urgent procedure. Ninety percent of long-term survivors were in New York Heart Association class I or II, and 87% believed having a heart operation after age 80 years was a good choice.
Conclusion Cardiac operations are successful in most octogenarians with increased hospital mortality, and longer hospital stay. Long-term survival and quality of life are good.read more
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Percutaneous transarterial aortic valve replacement in selected high-risk patients with aortic stenosis.
John G. Webb,Sanjeevan Pasupati,Karin H. Humphries,Christopher R. Thompson,Lukas Altwegg,Robert Moss,Ajay Sinhal,Ronald G. Carere,Brad Munt,Donald R. Ricci,Jian Ye,Anson Cheung,Sam V. Lichtenstein +12 more
TL;DR: Percutaneous valve replacement may be an alternative to conventional open heart surgery in selected high-risk patients with severe symptomatic aortic stenosis in whom there was a consensus that the risks of conventional openheart surgery were very high.
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John G. Webb,Mann Chandavimol,Christopher R. Thompson,Donald R. Ricci,Ronald G. Carere,Brad Munt,Christopher E. Buller,Sanjeevan Pasupati,Samuel V. Lichtenstein +8 more
TL;DR: This initial experience suggests that percutaneous transarterial aortic valve implantation is feasible in selected high-risk patients with satisfactory short-term outcomes.
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Treatment of Calcific Aortic Stenosis With the Percutaneous Heart Valve: Mid-Term Follow-Up From the Initial Feasibility Studies: The French Experience
Alain Cribier,Hélène Eltchaninoff,Christophe Tron,Fabrice Bauer,Carla Agatiello,Deborah Nercolini,Sydney Tapiero,Pierre Yves Litzler,Jean Paul Bessou,Vasilis Babaliaros +9 more
TL;DR: Percutaneous heart valve implantation is feasible in inoperable patients with end-stage AS leading to hemodynamic and clinical improvement, and Continued advances and improved patient selection should decrease adverse events in the near future.
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Transapical Transcatheter Aortic Valve Implantation in Humans Initial Clinical Experience
Samuel V. Lichtenstein,Anson Cheung,Jian Ye,Christopher R. Thompson,Ronald G. Carere,Sanjeevan Pasupati,John G. Webb +6 more
TL;DR: Transapical aortic valve implantation without cardiopulmonary bypass was successfully performed in 7 patients in whom surgical risk was deemed excessive because of comorbidities and this initial experience suggests that transapicalAortic Valve Implantation without Cardiopul pulmonary bypass is feasible in selected patients with aortIC stenosis.
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Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial.
TL;DR: Patients aged 75 years or older with angina despite standard drug therapy benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life.
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