Short-term and long-term results of cardiac surgery in elderly and very elderly patients

Khalil Fattouch, Donald Cristell, Giuseppe Nasso, Georges Popoff, Claudio Zussa, Giuseppe Speziale, Ernesto Greco, Luigi Tavazzi, Vincenzo Argano, Sergio Chierchia, Maria Cristina Barattoni, Pasquale Caldarola, Marcio Scorcin, Giampiero Esposito, Roberto Coppola, Alfredo Marchese

Risultato della ricerca: Article

30 Citazioni (Scopus)

Abstract

Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright © 2011 by The American Association for Thoracic Surgery.
Lingua originaleEnglish
pagine (da-a)725-731
Numero di pagine7
RivistaJournal of Thoracic and Cardiovascular Surgery
Volume141
Stato di pubblicazionePublished - 2011

Fingerprint

Thoracic Surgery
Mortality
Aortic Valve
Counterpulsation
Cardiopulmonary Bypass
Thoracic Aorta
Ethics
Blood Transfusion
Patient Selection
Lung Diseases
Coronary Vessels
Chronic Disease
Myocardial Infarction
Economics
Survival

All Science Journal Classification (ASJC) codes

  • Surgery
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine

Cita questo

Fattouch, K., Cristell, D., Nasso, G., Popoff, G., Zussa, C., Speziale, G., ... Marchese, A. (2011). Short-term and long-term results of cardiac surgery in elderly and very elderly patients. Journal of Thoracic and Cardiovascular Surgery, 141, 725-731.

Short-term and long-term results of cardiac surgery in elderly and very elderly patients. / Fattouch, Khalil; Cristell, Donald; Nasso, Giuseppe; Popoff, Georges; Zussa, Claudio; Speziale, Giuseppe; Greco, Ernesto; Tavazzi, Luigi; Argano, Vincenzo; Chierchia, Sergio; Barattoni, Maria Cristina; Caldarola, Pasquale; Scorcin, Marcio; Esposito, Giampiero; Coppola, Roberto; Marchese, Alfredo.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 141, 2011, pag. 725-731.

Risultato della ricerca: Article

Fattouch, K, Cristell, D, Nasso, G, Popoff, G, Zussa, C, Speziale, G, Greco, E, Tavazzi, L, Argano, V, Chierchia, S, Barattoni, MC, Caldarola, P, Scorcin, M, Esposito, G, Coppola, R & Marchese, A 2011, 'Short-term and long-term results of cardiac surgery in elderly and very elderly patients', Journal of Thoracic and Cardiovascular Surgery, vol. 141, pagg. 725-731.
Fattouch, Khalil ; Cristell, Donald ; Nasso, Giuseppe ; Popoff, Georges ; Zussa, Claudio ; Speziale, Giuseppe ; Greco, Ernesto ; Tavazzi, Luigi ; Argano, Vincenzo ; Chierchia, Sergio ; Barattoni, Maria Cristina ; Caldarola, Pasquale ; Scorcin, Marcio ; Esposito, Giampiero ; Coppola, Roberto ; Marchese, Alfredo. / Short-term and long-term results of cardiac surgery in elderly and very elderly patients. In: Journal of Thoracic and Cardiovascular Surgery. 2011 ; Vol. 141. pagg. 725-731.
@article{d561417246154b45935ca53c851d73c5,
title = "Short-term and long-term results of cardiac surgery in elderly and very elderly patients",
abstract = "Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5{\%}, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4{\%}. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5{\%}. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright {\circledC} 2011 by The American Association for Thoracic Surgery.",
author = "Khalil Fattouch and Donald Cristell and Giuseppe Nasso and Georges Popoff and Claudio Zussa and Giuseppe Speziale and Ernesto Greco and Luigi Tavazzi and Vincenzo Argano and Sergio Chierchia and Barattoni, {Maria Cristina} and Pasquale Caldarola and Marcio Scorcin and Giampiero Esposito and Roberto Coppola and Alfredo Marchese",
year = "2011",
language = "English",
volume = "141",
pages = "725--731",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",

}

TY - JOUR

T1 - Short-term and long-term results of cardiac surgery in elderly and very elderly patients

AU - Fattouch, Khalil

AU - Cristell, Donald

AU - Nasso, Giuseppe

AU - Popoff, Georges

AU - Zussa, Claudio

AU - Speziale, Giuseppe

AU - Greco, Ernesto

AU - Tavazzi, Luigi

AU - Argano, Vincenzo

AU - Chierchia, Sergio

AU - Barattoni, Maria Cristina

AU - Caldarola, Pasquale

AU - Scorcin, Marcio

AU - Esposito, Giampiero

AU - Coppola, Roberto

AU - Marchese, Alfredo

PY - 2011

Y1 - 2011

N2 - Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright © 2011 by The American Association for Thoracic Surgery.

AB - Objective: Cardiac operations in elderly patients are increasingly frequent and imply major clinical, ethical, and economic issues. Operative and 5-year results of cardiac operations in patients aged 79 years or more are known in limited series, and a debate is ongoing on the appropriateness of selection of patients for surgery. Methods: We retrospectively reviewed our experience in 6802 patients aged 79 years or more who had received a cardiac operation. Surgical candidates were selected according to functional status, crude operative risk, and social context and were managed according to a multimodality protocol. Results: Mean age was 82 years and surgery was nonelective in 1613 cases (23.5%, 31 salvage). Procedures consisted of valve replacement (aortic, 2817; mitral, 532; and tricuspid, 2 cases), valve repair (aortic, 66; mitral, 532; and tricuspid, 232 cases), coronary bypass grafting (12,034 coronary vessels bypassed), and replacement of the thoracic aorta (ascending, 315; arch, 28 cases). Overall operative mortality was 3.4%. Nonelective presentation, need for aortic counterpulsation, cardiopulmonary bypass time, blood transfusion, depressed systolic function, and chronic lung disease predicted operative mortality. Five-year cumulative mortality was 7.5%. Poor systolic function, previous myocardial infarction, and combined coronary/mitral surgery predicted late mortality. The operative risk of nonagenarians operated on electively did not differ from that of risk-matched octogenarians. Conclusions: Cardiac surgery in elderly and very elderly patients can be performed with acceptable mortality provided that accurate selection and a multifactorial risk evaluation are adopted. Whenever possible, nonelective operations should be avoided and earlier surgery should be encouraged. Five-year survival and functional recovery are good. Copyright © 2011 by The American Association for Thoracic Surgery.

UR - http://hdl.handle.net/10447/120239

M3 - Article

VL - 141

SP - 725

EP - 731

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

ER -