ABSTRACT
BACKGROUND: The concept of frailty has become increasingly familiar in cardiac surgery. Since one of the characteristics of frailty is its reversible nature, efforts are being made to preoperatively decrease the level of frailty. However, the effect that the surgery itself may have in the postoperative frailty status remains still unknown. METHODS: A prospective cohort of 137 patients aged 70 or more undergoing major cardiac surgery were recruited at three hospitals in Spain. Frailty status was assessed preoperatively and six months after surgery using the Fried scale and the Clinical Frailty Scale (CFS). We analyzed the changes in these frailty scores and the transitions between frailty status after surgery. RESULTS: Mean age of participants was 78.3 years. 47.7% were female. Prevalence of frailty was 27.5% with the Fried Scale and 11% with the CFS. Up to 50% of frail patients improved their frailty status after surgery. The distribution of frailty among the study groups at baseline and six months after surgery changed significantly, decreasing the overall burden of frailty after surgery: 27.5% vs 17.4% of frail patients with the Fried Scale and 50.5% vs 29.4% of vulnerable or frail patients with the CFS (p<0.01). CONCLUSIONS: Frailty is a dynamic condition that can be significantly reduced after cardiac surgery, suggesting that cardiac pathology is an important contributor to the preoperative patient's frailty status.
Subject(s)
Cardiac Surgical Procedures , Frailty , Aged , Cohort Studies , Female , Frail Elderly , Frailty/epidemiology , Geriatric Assessment , Humans , Prospective StudiesABSTRACT
Resumen La radioterapia mediastínica es uno de los tratamientos fundamentales de las enfermedades malignas torácicas, pero también representa una causa potencial de complicaciones, tanto a corto como a largo plazo. Se presenta una serie de casos de rotura de vena innominada durante esternotomía media en pacientes con fibrosis mediastínica. Los tres casos descritos corresponden a pacientes intervenidos de cirugía cardiaca con antecedentes de radioterapia mediastínica, entre 15-30 años antes de la cirugía, por tres diferentes enfermedades malignas (linfoma de Hodgkin, timoma y cáncer de mama). En los tres casos se reporta rotura de la vena innominada, con desinserción de su origen en la vena cava superior debido a fibrosis mediastínica intensa.
Abstract Although mediastinal radiotherapy is one of the basic treatments of malignant thoracic diseases, it is also a potential cause of short and long-term complications. A series of cases of rupture of the innominate vein during sternotomy are presented in patients with mediastinal fibrosis. The three cases described correspond to patients intervened by cardiac surgery, with a history of mediastinal radiotherapy between 15 to 30 years before the surgery, due to three different malignant diseases (Hodgkin lymphoma, thymoma, and breast cancer). In the three cases, a rupture of the innominate vein is reported; with de-insertion of its origin in the superior vena cava sue to intense mediastinal fibrosis.
