Cardiac surgery in the octogenarian: nursing implications.

OBJECTIVE: To determine morbidity and mortality rates in octogenarians undergoing cardiac surgical repairs and to compare these results with a similar group of younger patients. DESIGN: Retrospective, two-group. SETTING: Midwestern university medical center. SUBJECTS: Group I consisted of 235 male and female patients who were all less than 80 years of age. Group II consisted of 235 male and female patients who were 80 years of age or older. Both groups underwent similar cardiac surgical procedures. OUTCOME MEASURES: Development of postoperative complications, length of hospitalization, and mortality. RESULTS: When comparing octogenarians with younger patients, octogenarians developed significantly more postoperative complications with higher operative mortality. In addition, octogenarians were hospitalized significantly longer than the younger group. CONCLUSION: These findings suggest that age is a major risk factor influencing outcome after surgery. However, by incorporating nursing interventions with geriatric concepts, those postoperative complications that are common in octogenarians may be more effectively treated and possibly prevented. With sensitive and knowledge-based care, most older patients can anticipate good recovery after cardiac surgery.

Right atrial versus aortic root perfusion with blood cardioplegia.

The efficacy of coronary sinus cardioplegia administered into the right atrium has not been fully defined. Thirty-two consecutive patients undergoing elective myocardial revascularization were prospectively assigned to receive cold blood cardioplegia exclusively into the aortic root (15 patients) or the right atrium (17 patients). The two groups were similar with respect to age, ventricular function, severity of coronary disease, cross-clamp time, and mean infusate volume and temperature. Completeness of revascularization was greater in the aortic root cardioplegia group (p less than 0.007). The mean septal temperature and time to achieve electromechanical arrest was greater in the right atrial cardioplegia group (p less than 0.05). The right ventricular temperature and the release of myocardial isoenzyme were similar in both groups. Left and right ventricular stroke work index was preserved equally in both cohorts. Volume loading studies performed immediately after termination of bypass suggested better left ventricular function in the aortic root cardioplegia group. Myocardial performance with a loading challenge assessed late postoperatively was superior in the right atrial cardioplegia group (p less than 0.05). There were no differences between the groups with respect to clinical outcome. The data suggest that right atrial cardioplegia (1) possesses clinical safety equal to aortic root cardioplegia, (2) possesses inferior ventricular septal cooling, and (3) yields adequate preservation of both the right and left ventricles. We conclude that right atrial cardioplegia possesses no apparent advantage over aortic root delivery in the setting of elective myocardial revascularization.