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Published on: September 22, 2020
Cardiac surgery in patients with major lower extremity amputation: a single institution experience
Faisal G Bakaeen1, Danny Chu, Casiano Chi
1Baylor College of Medicine, Michael E DeBakey Veterans Affairs Medical Center, Texas Heart Institute at St Luke's Episcopal Hospital, Houston, TX 77030, USA. fbakaeen@bcm.edu
Insights
Cardiac surgery patients with lower-extremity amputations face challenges but achieve good functional recovery. Despite prolonged hospital stays, most patients with below-knee amputation (BKA) or above-knee amputation (AKA) return to their preoperative ambulatory status.
Area of Science:
- Cardiology
- Vascular Surgery
- Rehabilitation Medicine
Background:
- Patients undergoing cardiac surgery with lower-extremity amputations present unique medical and functional recovery challenges.
- Managing these complex patients requires careful consideration of comorbidities and rehabilitation pathways.
Purpose of the Study:
- To evaluate the outcomes and functional recovery of patients with lower-extremity amputations who underwent cardiac surgery.
- To identify potential challenges and success factors in this patient population.
Main Methods:
- A retrospective review of 10 patients with below-knee amputation (BKA) or higher amputation levels who underwent cardiac surgery between 1998 and 2008.
- Analysis of patient demographics, comorbidities, surgical procedures, hospital stay, and long-term functional outcomes.
Main Results:
- The study included patients with BKA (n=9) and above-knee amputation (AKA) (n=1), with significant comorbidities like diabetes and peripheral vascular disease.
- No operative deaths occurred. Median hospital stay was 12.5 days, with 8 patients requiring transfer to rehabilitation.
- At a median follow-up of 1.5 years, all but one patient were alive and had regained their preoperative ambulatory status.
Conclusions:
- Patients with lower-extremity amputations undergoing cardiac surgery typically require extended hospitalization.
- Despite prolonged recovery, these patients can achieve favorable mid-term functional recovery and return to their baseline mobility.
Background:
Cardiac surgery patients with lower-extremity amputations pose a challenge in terms of medical comorbidities and functional recovery.
Methods:
A retrospective review of all patients (n=10) with preexisting below-knee amputation (BKA) or more proximal amputation level who underwent cardiac surgery between April 1998 and April 2008. Data were analyzed to evaluate outcomes.
Results:
The median age was 59 y (range, 51-75 y). One patient had bilateral above-knee amputation (AKA), and 9 had BKAs (two bilateral). Comorbidities included diabetes (n=5), peripheral vascular disease (n=7), cerebrovascular disease (n=2), hypertension (n=9), chronic renal insufficiency (n=2), pulmonary hypertension (n=1), and pulmonary fibrosis (n=1). Nine patients underwent coronary artery bypass grafting and one patient underwent aortic valve replacement. There were no operative deaths. The median length of hospital stay (to home discharge) was 12.5 d (range, 5-562 d). Eight patients were transferred to a rehabilitation unit or a chronic care facility before being discharged to home. At follow-up (median, 1.5 y; range, 0.4-3.8 y), all but one patient were alive and had returned to their preoperative ambulatory status.
Conclusions:
In our experience, patients with lower-extremity amputations require prolonged hospitalization after cardiac surgery but can expect good mid-term outcomes and functional recovery.
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