Preserved Quality of Life in Octogenarians at Early, Mid, and Late Follow-Up Intervals Irrespective of Cardiac Procedure.

Cardiac surgery has become established in octogenarians over the past decade. This study assessed the quality of life (QOL) and survival in patients undergoing various cardiac procedures at various time intervals postoperative. Patients older than 80 years at the time of their cardiac procedure were initially included (n = 427). Patients were grouped according to the time interval from their operations namely as within 3 years postoperative (Group A), 3-5 years postoperative (Group B), and older than 5 years postoperative (Group C). Patients who were at least 2 years postoperative and who were still alive were sent the Medical Outcomes Study Short Form 12 Health Survey version 2 QOL questionnaire (n = 308). In results, there were no significant differences in the preoperative characteristics among the groups including type of surgery and logistic Euroscore. There were also no significant differences in the immediate postoperative phase in the complication rates except for renal replacement therapy (P < 0.01). At follow-up, a further 20 patients had died, and for those still alive 87% (61 of 70), 86% (86 of 100), and 74% (87 of 118) of patients returned questionnaire for each group, respectively. There were no significant differences in mental scores (P = 0.3) and physical scores (P = 0.07) among the groups at the various time intervals. This was irrespective of the type of surgery performed on multivariate analysis. Moreover, most octogenarians who underwent cardiac surgery had equivalent or better QOL than expected when compared with the general population of the same age and sex. In conclusion, the QOL in octogenarians undergoing cardiac surgery is preserved, irrespective of the interval from and the type of procedure. Octogenarians enjoy a good QOL, both physical and mental performance, irrespective of the time interval after surgery and the type of cardiac surgery that they have undergone. Based on these data, any type of cardiac surgery should still be an option in this age group including complex cardiac procedures.

Significant reduction in ventilator-associated pneumonia with the Venner-PneuX System in high-risk patients undergoing cardiac surgery: the Low Ventilator-Associated-Pneumonia study.

OBJECTIVES: This study assessed whether the Venner-PneuX endotracheal tube (ET) system, which has sub-glottic suction as well as irrigation ports and continuous cuff-pressure monitoring, is associated with a reduction in ventilator-associated pneumonia (VAP) when compared with the standard ET in high-risk patients undergoing cardiac surgery. METHODS: This was a single-institution, prospective, randomized control trial. Patients were categorized as either Group A (Venner-PneuX ET tube, n = 120) or Group B (Standard ET tube, n = 120). Inclusion criteria included patients over the age of 70 years and/or impaired left ventricular function (LVEF <50%) undergoing cardiac surgery. Patients were monitored for VAP for up to 48 h post extubation and the diagnosis of VAP was according to the centres for disease control definition. RESULTS: There were no significant differences in the patients' demographics. The mean (SD) ages for the two groups were 72.4 (8.2) and 72.1 (7.4) years (P = 0.6), respectively. The mean EuroSCORE was 6.39 (2.2) for Group A and 6.48 (2.6) for Group B (P = 0.9). The median intubation times were 14.7 (7.3, 2927.2) h and 13 (2.5, 528.7) h, respectively. VAP incidence was significantly lower in the Venner-PneuX ET group, being 10.8% when compared with 21% in the standard ET group (P = 0.03). There was no significant difference between the two groups in terms of intensive care unit stay (P = 0.2) and in-hospital mortality (P = 0.2). A binary logistic regression analysis (type of ET tube, age, LVEF, history of lung disease, smoking history, surgical procedure, EuroSCORE, cardiopulmonary bypass time, blood transfusion, intubation duration among others) confirmed that the Venner-PneuX ET tube was associated with significant VAP reduction (Odds ratio 0.45, P = 0.03). CONCLUSIONS: The Venner-PneuX VAP prevention system is associated with a significant reduction in VAP. This can potentially lead to significant cost reductions and should be implemented as part of the VAP reduction bundle.