Primary valvular surgery in octogenarians: perioperative outcome.

BACKGROUND AND AIM OF THE STUDY: Cardiac surgery in octogenarians is now performed routinely, and generally results in a good improvement in functional capacity. The study aim was to evaluate operative mortality and to identify preoperative and postoperative risk factors of mortality. METHODS: A total of 200 consecutive patients (79 males, 121 females; mean age 83 years; range: 80-90 years) who underwent valvular surgery at the authors' institution between 1991 and 2002 was reviewed. Among patients, 154 underwent aortic valve replacement (77.0%), 35 mitral surgery (17.5%), and 11 aortic and mitral valve surgery (5.5%). Forty-five patients (22.5%) had concomitant myocardial revascularization, and 23 (11.5%) were operated on in an emergency setting. Preoperative risk factors studied included endocarditis (2.0%), ventricular dysfunction (22.5%), pulmonary hypertension (33.5%), renal dysfunction (31.5%), chronic obstructive pulmonary disease (7.0%) and arteriopathy (9.0%). The mean EuroSCORE, which was used to assess predicted operative risk, was 9.1; the score was < 9 in 104 patients (52%) and > 9 in 96 (48%). RESULTS: Hospital mortality was 7% (n = 14). There were no significant preoperative risk factors of mortality. Postoperative complications occurred in 115 patients (57.5%), including low cardiac output (16.0%), supraventricular arrhythmia (29.5%), pulmonary complications (9.5%), gastrointestinal ischemia (2.0%), wound infection (2.0%) and surgical re-exploration (5.5%). Low cardiac output (p < 0.001), gastrointestinal ischemia (p = 0.03) and surgical reexploration (p = 0.004) were significant risk factors of mortality. CONCLUSION: Valvular surgery in octogenarians is a safe and low-risk procedure. The present data tended to show that the EuroSCORE overestimates mortality in this group of patients.

Off-pump coronary surgery in selected patients: better early outcome but more recurrence of angina?

This non-randomized retrospective study included all patients operated on for CABG through median sternotomy between January 2000 and December 2002 by the same surgeon trained to both techniques. Using risk-adjusted comparison where expected mortality was given by the EuroSCORE value assessed pre-operatively, and studying mid-term survival and functional results we aimed to evaluate our indications for OPCAB versus conventional CABG through a consecutive series of 308 patients. Selected indications for OPCAB (n=154) were isolated LAD coronary system lesions and multivessel diseases with suitable anatomy in high surgical risk patients (EuroSCORE > or = 5). The first 154 patients operated on conventionally during the time-study interval were included in the control group. Expected mortality was significantly higher in the OPCAB group: 4.29 [95% CI: 3.83-4.77] vs. 3.54 [95% CI: 3.17-3.91] (P=0.024). Observed mortality was 1.3% and 2.6% for patients treated OPCAB and with conventional technique, respectively. Survival at three years was 91.5 and 93.8% in the conventional and OPCAB groups, respectively. Angina-free survival at three years was 95.8% and 89.6% in the conventional and OPCAB groups, respectively (P=0.04). To promote OPCAB in selected patients results in decreasing operative risk to the price of worsening late functional results.

A novel, valveless ventricular assist device: the FishTail pump. First experimental in vivo studies.

This article presents the first in vivo experiments with a new type of valveless ventricular assist device, a wave-generating pump. Our goal was to evaluate the hemodynamic performance of the pump by comparing it with the Biomedicus BP-80 centrifugal pump and by sustaining a 3 h long left ventricular assistance. We connected the two pumps in parallel and switched between them. We increased the aspiration by increments of -10 mm Hg at the inlet and measured developed flow, right carotid and femoral pressure, left atrial pressure, and left carotid flow. Then, we let the FishTail perform a 3 h long left ventricular assistance. The mean developed flow on the outlet was higher with the FishTail, with statistical significance, but this difference was not clinically significant. However, we observed an important amount of hemolysis during the ventricular assistance period. Although promising, this novel pumping device needs further prototypes to be clinically applicable.

Parsonnet's risk score predicts late survival but not late functional results after aortic valve replacement in octogenarians.

BACKGROUND AND AIM OF THE STUDY: The study aim was to assess whether outcome after aortic valve replacement (AVR) in octogenarians can be anticipated by their preoperative clinical status. METHODS: Early and late results of 101 consecutive patients operated on for AVR between 1988 and 1998 in the authors' department were reviewed. Data were compared for two patient groups determined by Parsonnet's risk score (PRS) values: group A (n = 42), PRS <30, and group B (n = 59), PRS > or =30. RESULTS: Hospital mortality was 7.1% in group A and 16.9% in group B (p = NS). Follow up was complete (total 268 patient-years; mean 2.7 years per patient). Five- and eight-year survival rates were 76% and 39% in group A, and 57% and 16% in group B (p <0.05). Late mortality was mainly related to non-cardiac causes. Among 61 survivors on completion of follow up, functional results (mean NYHA class and mean Karnofsky score) were 1.5+/-0.8 versus 1.5+/-0.7 and 61+/-18 versus 61+/-17 in groups A and B, respectively. Among survivors, 24/31 from group A versus 22/30 from group B were still living in their own home. CONCLUSION: These results indicated that the PRS overestimated the operative risk of AVR in octogenarians. PRS also appeared to be related to late survival in these patients, but did not predict any postoperative functional benefits.