Aims: Best popular perception that coronary artery bypass grefting in octogenarians carries high risk related primarily to advanced age. Nevertheless, the effects of CABG, percutaneous coronary intervention , and medical treatment were not assessed on life adequately.
Material and Methods: In the present study, survival duration of 375 octogenarian patients who underwent coronary angiography (CAG) in our clinic was evaluated retrospectively.
Results: Patients were assigned and compare to seven groups as follows: group 1, patients with normal CAG results; group 2, patients with diffuse coronary narrowness who received medical treatment, group 3, patients who underwent PCI, group 4 was the subgroup of patients from group 3 who underwent PCI in the left anterior descending artery only or in combination with their coronary arteries; group 5, patients in critical condition who were unavailable for any intervention because of cardiac function, group 6, patients who underwent CABG; and group 7, patients who declined the recommended CABG and PCI. For each group, the first-year survival rates were respectively: 100%, 95%, 91.2%, 91.8%, 76.1%, 93.0%, 90.82%. After 6 years, the survival rates were respectively: 76.1%, 80.0%, 72.5%, 71.42%, 52.3%, 90.2%, 76.14%. Rates of patients living by years a significant correlation was revealed between group 6 and group 2 and group 3 (p=0.001, p = 0.004). Group 3 was found to have a significant correlation with Group 4 and Group 7 (p=.000). Group 7 was significantly correlated with groups 3 (p = 0.000), 4 (p = 0.000), and 2 (p = 0.007).
Conclusion: Especially in octogenarians who had shortness of the expected survival, the surgical advantage of visual anastomotic replacement, and complete vascularization were successed more than PCI.
We admitted a maintenance haemodialysis patient with hypotension and weakness.
He had undergone cadaveric renal transplantation 19 years earlier. He had lost his kidney due to chronic allograft nephropathy 1 year after transplantation and returned to haemodialysis. He had hypotension, especially remarkable during haemodialysis. He also had hepatitis C but no cirrhosis. The patient denied a previous pulmonary tuberculosis. On physical examination, he was hypotensive (80/60 mmHg) but without peripheral oedema, neck vein distention or hepatomegaly. Heart sounds were weakly heard and there was no audible murmur or friction rub. Pericardial calcification was noticed on chest x-ray (Figure (Figure1).1). Echocardiography could not visualize the pericardium or heart. Only coarse calcification of the pericardium from the subphrenic angle, but no further detail, was visible. Subsequently, we performed computerized tomography of the pericardium (Figure (Figure2),2), which revealed a crescent-like calcification of the pericardium. There were calcific plaques on the right lower lobe of the pulmonary pleura as well.
Fig. 1
Postero-anterior chest x-ray showing crescent-like pericardial calcification. Note also that calcification in the pleura overlying right lower lung.
Fig. 2
Coronal section of computerized tomography of the chest depicting crescent-like calcification of the pericardium encasing heart and right lower pleural calcification.
The presence of pericardial calcification strongly suggests constrictive pericarditis (CP) in patients with symptoms and signs of heart failure. A myriad of disease states can cause pericardial calcification. In the Western world, the most common cause is idiopathic. However, in the developing countries, tuberculosis remains an important cause. Plain chest radiographs can display calcification. Echocardiography may confirm the diagnosis, showing a thickened pericardium and calcification in some cases. However, normal echocardiography does not rule out CP. Transoesophageal echocardiography is more sensitive; however, the gold standard for diagnosis is invasive haemodynamic evaluation. Patients with CP may present with two types of complaints: those related to fluid overload, ranging from peripheral oedema to anasarca; and those related to a diminished cardiac output response to exertion, such as fatiguibility and dyspnoea. These symptoms may be masked in haemodialysis patients due to ultrafiltration and close volume regulation.
Conflict of interest statement. None declared.
To analyse the experience of a cardiac surgery centre with all types of cardiac interventions in the elderly in order to evaluate outcomes.The retrospective study was conducted at Middle East Hospital, Mersin, Turkey, and comprised data of patients aged 70 years who underwent cardiac surgery from December 1, 2010, to March 31, 2016. Clinical outcomes, postoperative length of hospital stay and mortality rates were evaluated. SPSS version 15 software for Windows (IBM Corporation, Armonk, NY) was used for data analysis.Of the 1920 cases, 276(14.35%) patients were aged >70 years. Of them, 70(25.4%) were males and 206(74.6%) were females. The overall mean age was 71.39±2.26 years (range: 70-82 years). Coronary artery bypass grafting was the most frequent intervention 268(97%). Of the total, 6(2.2%) patients were treated urgently and 1(0.4%) was treated very urgently. The mortality rate was 8(2.9%) Preoperative and intraoperative findings didn't affect outcomes (p>0.05), but variables predicting mortality and length of hospital stay included operation priority, postoperative neurological and pulmonary complications and wound infection (p<0.05 each).Morbidity and mortality rate was found to be acceptable in elderly patients who underwent cardiac surgery.
Amaç: Hastanede yatan ve beslenme desteği (BD) tedavisi alan hastalarda yetersiz beslenme, malnütrisyona bağlı komplikasyon riskini arttırmaktadır. Bu çalışmada hastanede yatan ve BD alan hastalarda, malnütrisyon durumu ve BD tedavisinin etkinliğinin ölçülmesi amaçlanmıştır.Bireyler ve Yöntem: Bu çalışmaya hastanede yatan, BD gereksinmesi nedeni ile beslenme destek ekibine danışılan ve izlenen 100 yetişkin (≥18 yaş) hasta dahil edilmiştir. Hastalarda malnütrisyon durumu Nütrisyonel Risk Değerlendirme Skoru-2002 (NRS-2002) ile değerlendirilmiştir. Beslenme destek tedavisi alan hastaların hedeflenen günlük enerji ve protein gereksinmelerine ulaşma süreleri günlük vizitler ile değerlendirilmiştir. Hastalar taburcu oluncaya kadar veya hastanede ölüm görülünceye kadar izlenmiştir. Hastaların ilk değerlendirmede ve izlem süresi sonunda haftalık olarak bazı biyokimyasal parametreleri değerlendirilmiştir. Hastaların klinik sonuçları, hastanede yatış süreleri ve mortalite görülme sıklığı kayıt edilmiştir.Bulgular: Hastanede BD ekibine danışılan hastalarda, NRS-2002 skoruna göre nütrisyonel risk altında olan hastaların sıklığı %75’tir. Hastalarda hedeflenen protein ve enerji gereksinmelerine ulaşma süresi sırasıyla ortalama 21.15±18.15 gün ve 19.56±17.14 gün’dür. İzlenen hastalarda mortalite görülme sıklığı %59’dur. Beslenme desteği tedavisine rağmen tüm hastaların BD tedavisi aldıkları son haftada serum protein değerleri (total protein ve albümin) düşmüştür (p<0.005). Serum albümin düzeyleri ve hastanede yatış süresi arasında pozitif yönde bir ilişki bulunmuştur. Düşük serum protein değerleri mortaliteyi olumsuz yönde etkilemiştir (p<0.01). NRS-2002 skoru ile belirlenen nütrisyonel risk mortaliteyi ve hastanede yatış süresini etkilememiştir (p>0.05).Sonuç: Bu çalışmada, BD ekibine danışılan hastaların klinik durumunun, BD tedavisinin etkinliğini değiştirdiğini ve bu nedenle hedeflenen BD tedavisine ulaşma süresinin çok geç olduğu düşünülmektedir. Klinikte BD tedavisi alan hastaların izlemleri düzenli olarak yapılmalı ve hedef stratejiler oluşturularak izlem süreçlerinin iyileştirilmesi gerekmektedir.
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