Cardiac surgery in 80 years old patients

Cardiac Rehabilitation (CR) plays a central role in early detection of physical limitations. Traditionally exercise tolerance has been used as an indicator of overall PF. However exercise tolerance has been shown to poorly predict patients’ ability to perform daily-life activities. The goal of the present study is to evaluate a new test, named VITTORIO TEST, for assessing various component of daily activities among patients in CR after cardiac surgery. VITTORIO test consists in 8 items that assess lower and upper extremity strength and flexibility, agility, dynamic balance, aerobic capacity. 500 patients (359 males; 141 females) admitted to CR programs following cardiac surgery (349 coronary artery bypass surgery; 151 valvular surgery) were enrolled in the study. They were evaluated with an initial test (T1) (10.7±6.3 days after cardiac surgery) and a final test (T2) after a inhospital intensive training program (mean length 16.8 ± 6.6 days) consisting in stretching, large muscle group and aerobic activity, resistance exercises. Statistical analysis showed a significant improvement of all items at the end of the rehabilitation program. Old patients (>70 years) and particularly females demonstrate exercise improvement comparable to that of younger subjects especially regards lower extremity strength and aerobic capacity. VITTORIO test is inexpensive, simple and easy to perform by the patient. Through the identification and the measurement of different aspects of physical disability, it allows a personalized rehabilitation exercise program. It could be used as an outcome measure of CR programs.

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How to develop a simply frailty score for predicting postoperative morbidity in cardiac surgery

Cardiology Open Access ◽

10.33140/coa/02/01/00001 ◽

2017 ◽

Vol 2 (1) ◽

Keyword(s):

Cardiac Surgery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Gait Speed ◽

Albumin Level ◽

Old Patients ◽

One Year ◽

Frailty Score

Introduction: Ageing and elderly people have greater risk. Physical state and frailty status represent an important risk and must be considered before cardiac surgery. More than one third of current surgeries are performed in patients older than 70 years. This is a factor to keep on mind in our routine evaluation. Currently an accepted definition for frailty is not well established. It has been considered as a physiological decline in multiple organ systems, decreasing the patient’s capacity to withstand the stresses of surgery and disease. The aim of our study was to determinate a correlation between preoperative features and the morbidity after cardiac surgery in aortic valve replacement population. Methods: We selected the 70 years old patients or older who underwent an elective aortic valve replacement. We collected prospectively all preoperative features and frailty traits (Barthel Test; Gait Speed test, Handgrip) also taking into account blood parameters like albumin level and hematocrit previous to the surgery, hospital admissions within 6 months, and we analyze the demographics and medical history of the patients. We compare patients who undergo to stented prosthesis, sutureless or Transcatheter prostheses (TAVI) procedure and follow up. Results: Two hundred patients were enrolled. The mean age was 78 years all. The predicted mortality with Logistic euroScore I was 12,8% with a real mortality lower than expected (3,5%). Pre-surgery frailty in our population was associated with a Gait Speed higher of 7 seconds, Barthel less of 90%, anemia with Hematocrit <32%, albumin level< 3,4g/dl, chronic renal failure, preoperative re-admission and artery disease. The TAVI group had higher morbidity, no differences statistically significant between Stented and sutureless prosthesis group. Frail individuals had longer hospital stays, readmissions and respiratory/ infectious complications. The mortality at 6 months /one year follow up was 4,1 % /0 % respectively; and morbidity (pacemaker implant, respiratory events, readmission); at 6 months /one year of follow up was 13,47 % to 3%. Conclusions: Elderly and frailty population present more complications after a cardiac surgery. A simple frailty score must be considered in cardiac population to avoid increased morbidity.

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The Influence of Approaches to Early Mobilization of Cardiosurgical Patients on the Duration of Hospitalization

Ukraïnsʹkij žurnal medicini bìologìï ta sportu ◽

10.26693/jmbs06.06.194 ◽

2021 ◽

Vol 6 (6) ◽

pp. 194-199

Author(s):

V. V. Vitomskyi ◽

◽

M. V. Vitomska ◽

◽

Keyword(s):

Cardiac Surgery ◽

Intensive Care ◽

Physical Therapy ◽

Medical Staff ◽

Physical Therapist ◽

Early Mobilization ◽

Old Patients ◽

Therapeutic Exercises ◽

Duration Of Hospitalization ◽

The Impact

The purpose of the study was to compare the impact of approaches to early mobilization of cardiac surgery patients on the duration of hospitalization. Materials and methods. Early mobilization of patients after cardiac surgery and study of its effectiveness is an important issue of physical therapy. The beginning of the development of cardiac surgery was characterized by the fact that patients after surgery were in the intensive care unit on a bed rest for several days to improve recovery and prevent complications. The benefits of early mobilization were later recognized, and patient verticalization began earlier. The study involved 90 patients (over 18 years old). Patients were divided into two groups. The first group of mobilization (GM1, n = 49) included patients who underwent surgery on Monday or Tuesday, performed standing and if possible walking on the spot on the first postoperative day with a physical therapist. The second group of mobilization (GM2, n = 41) included patients who underwent surgery on Friday, were mobilized to sit in bed on the first postoperative day; performed standing and walking on the spot on the second or third postoperative day with the participation of medical staff. In addition, other early mobilization points (chamber walking and corridor walking) were performed statistically later in GM2. Patients did not differ in other features of physical therapy. All patients were told during the preoperative consultation with a physical therapist that if they were operated on Friday, they would perform mobilization and therapeutic exercises with medical staff on weekends. Patient case data (age, sex, study protocols and operations) were studied. Results and discussion. Among GM1 patients, the part of men was 69.39%, and in the GM2 group – 78.05% (χ² = 0.856; p = 0.355). Groups of patients did not have significant differences in age, anatropometric parameters, key results of preoperative studies, characteristics of surgical interventions. The study did not establish the effect of more progressive early mobilization performed in GM1 on the length of stay in the postoperative ward (7 (6; 8) nights versus 7 (5; 8) nights; p=0.428) and the total duration of postoperative hospitalization (9 (8; 10) nights against 10 (7; 11) nights; p=0.733). Statistically better indicators of the GM1 group were obtained in the number of nights spent in intensive care (all patients – two nights, except 3 patients in GM1 and 11 in GM2 – three nights; p=0.007), but this advantage should be considered taking into account the impact of patient logistics, namely longer stay in intensive care on weekends. Conclusion. The data confirmed the same effectiveness of approaches to early mobilization of cardiac surgery patients in terms of duration of postoperative hospitalization

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FC28-04 - Quality of life assessment after cardiac surgery in octogenarians: Is it really feasible?

European Psychiatry ◽

10.1016/s0924-9338(11)73677-x ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1974-1974 ◽

Cited By ~ 1

Author(s):

G. Pontoni ◽

S. Ferrari ◽

D. Gabbieri ◽

M. Pedulli ◽

D. Gambetti ◽

...

Keyword(s):

Quality Of Life ◽

Cardiac Surgery ◽

Treatment Satisfaction ◽

Depression Scale ◽

Life Assessment ◽

Self Administration ◽

Old Patients ◽

Cardiac Symptoms ◽

Sf 36

IntroductionCardiac surgery is being performed more frequently in octogenarians with huge pressure on health care resources. Quality of Life (QoL) improvement should be the primary goal in this high-risk patients.Aims/objectivesThis study evaluates the feasibility of QoL assessment in octogenarians after cardiac surgery.MethodsQoL was assessed by three self-administered psychometric tests: modified Seattle Angina Questionnaire, SF-36, and Hospital Anxiety and Depression Scale. QoL was evaluated after a mean time of 5.5 years after operation in 86 patients, and before and 6 months after surgery in 21 patients.ResultsRetrospective evaluation of QoL showed absence of physical limitation in 50% of patients, treatment satisfaction in 80%, symptoms-free conditions in 62%, poor or absent disease perception in 94%, satisfactory wellbeing and enjoyment of life in 78%. QoL six-month variance analysis showed significant improvement in 4 of 5 modified SAQ domains (except of Treatment Satisfaction), 6 of 8 SF-36 domains (except of Emotional Role Limitation and Vitality), and in both depression and anxiety HADS subscales. However, test's self-administration failed, always necessitating physician and relatives’ help. Moreover, several questions showed to be unfit for this subset of patients.ConclusionsDespite the emerged limitations using these tests, cardiac surgery seems to improve QoL in octogenarians with cardiac disease. After 5 years the prevalence of physical disability, cardiac symptoms and functional limitation due to cardiac symptoms, are comparable to the overall octogenarian population. QoL improvement appears more evident 6 months after the operation. New suitable tests are required for old patients.

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