Long-Term Quality of Life after Cardiac and Thoracic Aortic Surgery for Very Elderly Patients 85 Years or Older.

PURPOSE: We evaluated the outcomes of open heart surgery and long-term quality of life for patients 85 years and older. METHODS: We enrolled 46 patients 85 years and older who underwent cardiac and thoracic aortic surgery between May 1999 and November 2012. Long-term assessment was performed for 43 patients; three patients who died in the hospital were excluded. Patient conditions were assessed before surgery, 6 months and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness. RESULTS: Three patients (6.5%) died during hospitalization and 22 (51%) died during the follow-up period. The 1-, 3-, 5-year survival rates were 74%, 49%, and 36%. During the late period, of 21 surviving patients, 18 patients (85%) were living at home. The need for nursing care was comparable before and after surgery. The degree of independent living decreased after surgery. Living willingness was similar before and after surgery. CONCLUSION: Among patients 85 years or older who underwent open heart surgery, 85% were living at home. All patients could perform activities of daily living without any assistance while maintaining living willingness.

[Repair of Cardiac and Pulmonary Damage caused by Stabbing with a Kitchen Knife;Report of a Case].

A 51-year-old woman was stabbed in the chest with a kitchen knife. Twenty minutes after arrival at our hospital by ambulance, she was transferred to the operating room, and a cardiopulmonary bypass was established from the right femoral artery and vein, and a median sternotomy was performed. The knife had damaged the surface of the heart and penetrated the lingular segment of the left lung. Both wounds were directly sutured. Chest X-rays taken after closing the chest showed bleeding in the left lung probably because of the administration of heparin. Bleeding was controlled by lingulectomy. The postoperative course was uneventful.

Risk factors of posterior pericardial annuloplasty for isolated posterior leaflet prolapse.

BACKGROUND: Posterior autologous pericardial annuloplasty is an option in mitral valve repair. However, the durability of posterior pericardial annuloplasty remains controversial. METHODS: From June 1999 to July 2004, 49 patients (18 male and 31 female; mean age, 64 +/- 12 years) with isolated posterior leaflet prolapse received posterior autologous pericardial annuloplasty. Transthoracic echocardiographic examination before the operation, at the time of discharge, and then annually was performed and analyzed. RESULTS: There was no incidence of in-hospital or late death. Only 1 patient (2.1%) required reoperation. In terms of recurrent mitral regurgitation, 31 patients (64.6%) exhibited grade 0 mitral regurgitation, 7 patients (14.6%) exhibited grade 1, and 9 patients (18.8%) exhibited grade 2, whereas only 1 patient (2.0%) exhibited more than grade 3. In terms of predicting postoperative recurrence of significant mitral regurgitation (> or =grade 2), multivariate Cox analysis demonstrated that marked left atrial dilatation and high fractional shortening were independent risk factors. In 8 of 10 patients significant mitral regurgitation recurred after discharge. In terms of left atrial dimension, no significant reduction was observed in the postdischarge recurrent group, and there was a significant difference of left atrial dimension between the postdischarge recurrent group and the nonrecurrent group at the time of discharge. CONCLUSIONS: The merits of mitral valve repair using posterior autologous pericardial annuloplasty are attractive. However, its use should be limited in selected patients with isolated posterior leaflet disease, nonenlarged atria, and non-high fractional shortening to maintain the durability of the mitral valve repair.