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[Cardiac surgery in the elderly: perioperative care and operative strategies]
1Abteilung für Herzchirurgie, Herzzentrum Lahr/Baden. alexander.albert@heart-lahr.com
Insights
Elderly patients benefit from cardiac surgery, improving quality of life. Minimally invasive techniques and careful preoperative optimization reduce risks and enhance outcomes for geriatric cardiac interventions.
Area of Science:
- Cardiology
- Geriatric Medicine
- Surgical Innovation
Background:
- Increasing prevalence of cardiac diseases in the elderly population drives demand for cardiac surgical interventions.
- Cardiac operations offer significant improvements in quality of life and life expectancy for geriatric patients.
- Benefits of cardiac surgery, including complete revascularization and biological aortic valve replacement, are long-lasting.
Observation:
- Minimally invasive approaches, such as Off-Pump Coronary Artery Bypass (OPCAB) with aortic non-touch technique, significantly reduce surgical trauma and stroke risk (<1%).
- Surgical indications should be guided by age-independent, evidence-based guidelines, with risk assessment based on comorbidities rather than age alone.
- Patient selection requires thorough assessment of surgical risk, expectations, and stress coping abilities, alongside elective timing and preoperative optimization.
Findings:
- Preoperative optimization, including blood sugar control, thyroid function, treatment of infections, anemia, and depression, is crucial for a positive prognosis.
- Geriatric patients are prone to postoperative complications such as low cardiac output, renal failure, respiratory insufficiency, and stroke.
- These patients require intensive postoperative care to manage potential complications effectively.
Implications:
- Optimized preoperative conditions and patient selection enhance the safety and efficacy of cardiac surgery in the elderly.
- Less-invasive surgical techniques are vital for reducing morbidity and improving recovery in older adults undergoing heart procedures.
- A multidisciplinary approach to geriatric cardiac surgery, focusing on risk mitigation and tailored postoperative care, is essential.
Abstract:
Caused by the age-dependent prevalence of cardiac diseases, the number of cardiac surgical interventions to geriatric patients is increasing. High life quality and life expectancy can be reached by cardiac operations. The advantage of cardiac surgical interventions is the decade's long positive effect. Accordingly also elderly benefit from complete revascularisation and from aortic valve replacement with biological prosthesis, which rarely degenerate in old age. A weak point is the surgical trauma, which can be reduced by less-invasive methods, such as OPCAB with aortic non-touch-technique, resulting in less than 1 % stroke. The indications for heart operations will be based on age-independent evidence-based guidelines. The decision for surgery is influenced by the expectation of the risk. This is defined by the co-morbidities and to lesser extent by the age per se. The operation risk can be calculated by risk-scores and hospital-specific data. The patient's expectations from the operation and his ability to overcome the accompanying stress must be thoroughly assessed. The operation must take place electively and at the right time. A good nutritional status and preoperative optimization of the organ functions are decisive for the prognosis. The blood-sugar-level must be optimized; thyroid function, (hidden) infections, anaemia and depression must be excluded or treated. The required screening tests should have been done already by the family doctor. The elderly are postoperatively susceptible to complications; especially low cardiac output, renal failure, respiratory insufficiency and stroke. Subsequently they need more intensive care.
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