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[Cardiac surgery in the elderly: patient selection criteria and results]
Giovanni Casali1, Francesco Musumeci
1U.O. di Cardiochirurgia, Azienda Ospedaliera San Camillo-Forlanini, Roma. casali@katamail.com
Insights
Selecting elderly patients for heart failure surgery requires balancing risks and benefits. Age and left ventricular dysfunction are not absolute contraindications, necessitating a global risk assessment for surgical candidacy.
Area of Science:
- Cardiology
- Geriatric Medicine
- Cardiac Surgery
Context:
- Elderly patients present unique challenges for cardiac surgery.
- Risk stratification is crucial for optimizing surgical outcomes in older adults.
- Heart failure surgery in the elderly requires careful consideration of comorbidities and surgical approach.
Purpose:
- To evaluate the criteria for selecting elderly patients for heart failure surgery.
- To assess the impact of age and left ventricular dysfunction on surgical risk.
- To determine the appropriate risk/benefit ratio for elderly patients undergoing mitral valve surgery.
Summary:
- Age and left ventricular dysfunction are independent mortality predictors but not absolute contraindications for heart failure surgery.
- Validated scoring systems aid in quantifying the global risk profile and individual variable impact.
- Mitral valve surgery in the elderly demands meticulous assessment due to higher associated mortality risks.
Impact:
- Identifies that a global risk profile, rather than age alone, should guide surgical decisions in elderly patients.
- Highlights the need for precise evaluation in elderly patients undergoing mitral valve surgery.
- Suggests that improved functional status and quality of life can justify surgery when risks are manageable, even if survival benefits are not definitively proven.
Abstract:
Selection of elderly patients for heart failure surgery is based on careful evaluation of the risk/benefit ratio. The global risk profile and the single variable impact can be easily quantified by using validated scoring systems. Both age and left ventricular dysfunction are independent determinants of mortality; nevertheless they cannot be considered absolute contraindications for surgery. Risk of mortality is related to age in a linear fashion; consequently an age cut-off value for excluding patients from surgery cannot be defined. The presence of other risk factors and the resulting global risk profile have to be considered to identify suitable patients for surgery. Elderly patients undergoing mitral valve surgery need a particularly accurate assessment since mitral procedures are associated with an increased short- and medium-term mortality; hemodynamic instability, renal failure, advanced heart failure and concomitant coronary surgery might contraindicate surgery. A significant improvement in the functional status and quality of life justifies surgical treatment of elderly patients when the predicted risk is reasonable although benefits in terms of increased survival have not been clearly confirmed yet.
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