RESUMEN
BACKGROUND: With the progressive aging of western populations, cardiac surgeons are increasingly faced with elderly patients. METHODS: We reviewed the records of 191 consecutive patients aged 80 years or older (mean age, 83 +/- 2.4 years) who underwent a cardiac surgical procedure at our institution from 1991 through 1996. RESULTS: Ninety-eight patients were men. Preoperatively, 32% of patients were in New York Heart Association class III or IV, and mean left ventricular ejection fraction was 0.55 +/- 0.02. One hundred ten patients (58%) underwent aortic valve replacement, 47 (25%) had coronary artery bypass grafting, 26 (14%) had combined aortic valve replacement and coronary artery bypass grafting, 5 (3%) underwent mitral valve replacement, and 3 (1.6%) had other procedures. Postoperative complications occurred in 69.1% of patients. The hospital mortality rate was 16.2%. Actuarial survival estimates at 1 year, 3 years, and 5 years were 79.2%, 74.9%, and 56.2%, respectively. Multivariate predictors (p < 0.05) of hospital death were preoperative pulmonary hypertension and lower left ventricular ejection fraction. Multivariate predictors of late death were combined aortic valve replacement and coronary artery bypass grafting and female sex. Sixty-four percent of long-term survivors were fully autonomous, and female sex was the only independent predictor of impaired autonomy. Eighty-three percent of survivors were satisfied with their present quality of life. CONCLUSIONS: Cardiac operations can be performed in octogenarians with a favorable long-term outcome. Earlier referral and intervention is mandatory to improve results in this patient population.
Asunto(s)
Anciano de 80 o más Años/estadística & datos numéricos , Puente de Arteria Coronaria/estadística & datos numéricos , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Actividades Cotidianas , Análisis Actuarial , Anciano , Anciano de 80 o más Años/fisiología , Anciano de 80 o más Años/psicología , Válvula Aórtica/cirugía , Causas de Muerte , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Femenino , Estudios de Seguimiento , Francia/epidemiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Mortalidad Hospitalaria , Humanos , Hipertensión Pulmonar/epidemiología , Masculino , Válvula Mitral/cirugía , Análisis Multivariante , Satisfacción del Paciente , Calidad de Vida , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Volumen Sistólico , Tasa de Supervivencia , Resultado del Tratamiento , Disfunción Ventricular Izquierda/epidemiología , Función Ventricular IzquierdaRESUMEN
A type II heparin-induced thrombocytopenia (HIT) was diagnosed in a 64-year-old woman at day 20 of intravenous unfractionated heparin (UFH) therapy, given after myocardial infarction treated by angioplasty and intracoronary stent. The infarction was complicated by a mitral insufficiency that led to a mitral valve replacement. Cardiopulmonary bypass was successfully performed with sodium danaparoid (Orgaran), as an alternative to UFH, without thrombotic or haemorrhagic complications and the follow-up was uneventful.