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Cardiac Surgery in the Elderly

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Surgical Decision Making in Geriatrics

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Abstract

Cardiac disease is one of the most common chronic conditions among adults and is the leading cause of death with advancing age. As people age, the incidence, prevalence, and severity of cardiac disease progress. Surgical management is often indicated with the progression of coronary artery disease, valvular heart disease, and aortic disease. As a result, over half of cardiac surgical procedures are performed in patients over 70 years of age. Outcome data indicates that surgical management of coronary artery disease, valvular heart disease, and aortic disease in the elderly is safe with low associated mortality and preservation of quality of life. These findings hold true in well-selected octogenarians and nonagenarians.

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References

  1. United States Census Bureau. Older people projected to outnumber children for first time in U.S. History. 2018. Available from: https://census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html.

  2. Weintraub WS, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012;366(16):1467–76.

    CAS  PubMed  PubMed Central  Google Scholar 

  3. Ando T, et al. Is transcatheter aortic valve replacement better than surgical aortic valve replacement in patients with chronic obstructive pulmonary disease? A nationwide inpatient sample analysis. J Am Heart Assoc. 2018;7(7):e008408.

    PubMed  PubMed Central  Google Scholar 

  4. Centers for Disease Control and Prevention (CDC). Prevalance of coronary heart disease – United States, 2006–2010. 2011. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a1.htm.

  5. U.S Department of Health and Human Services, Centers for Disease Control and Prevention. Summary health statistics: National Health Interview Survey, 2017. 2017 [cited 2019; Available from: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/NHIS/SHS/2017_SHS_Table_A-1.pdf.

  6. Patel MR, et al. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 appropriate use criteria for coronary revascularization in patients with acute coronary syndromes: a report of the American College of Cardiology appropriate use criteria task force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons. J Am Coll Cardiol. 2017;69(5):570–91.

    PubMed  Google Scholar 

  7. Likosky DS, et al. Long-term survival of the very elderly undergoing coronary artery bypass grafting. Ann Thorac Surg. 2008;85(4):1233–7.

    PubMed  Google Scholar 

  8. Yamaji K, et al. Effects of age and sex on clinical outcomes after percutaneous coronary intervention relative to coronary artery bypass grafting in patients with triple-vessel coronary artery disease. Circulation. 2016;133(19):1878–91.

    PubMed  Google Scholar 

  9. Iung B, Vahanian A. Epidemiology of valvular heart disease in the adult. Nat Rev Cardiol. 2011;8(3):162–72.

    PubMed  Google Scholar 

  10. Nishimura RA, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2017;135(25):e1159–95.

    PubMed  Google Scholar 

  11. Ross J Jr, Braunwald E. Aortic stenosis. Circulation. 1968;38(1 Suppl):61–7.

    PubMed  Google Scholar 

  12. Lester SJ, et al. The natural history and rate of progression of aortic stenosis. Chest. 1998;113(4):1109–14.

    CAS  PubMed  Google Scholar 

  13. Johnston LE, et al. Outcomes for low-risk surgical aortic valve replacement: a benchmark for aortic valve technology. Ann Thorac Surg. 2017;104(4):1282–8.

    PubMed  PubMed Central  Google Scholar 

  14. Melby SJ, et al. Aortic valve replacement in octogenarians: risk factors for early and late mortality. Ann Thorac Surg. 2007;83(5):1651–6; discussion 1656–7.

    PubMed  Google Scholar 

  15. Thourani VH, et al. Long-term outcomes after isolated aortic valve replacement in octogenarians: a modern perspective. Ann Thorac Surg. 2008;86(5):1458–64; discussion 1464–5.

    PubMed  Google Scholar 

  16. Barreto-Filho JA, et al. Trends in aortic valve replacement for elderly patients in the United States, 1999–2011. JAMA. 2013;310(19):2078–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Mack MC, et al. Outcomes of treatment of nonagenarians with severe aortic stenosis. Ann Thorac Surg. 2015;100(1):74–80.

    PubMed  Google Scholar 

  18. Elgendy IY, et al. In-hospital outcomes of transcatheter versus surgical aortic valve replacement for nonagenarians. Catheter Cardiovasc Interv. 2019;93(5):989–95.

    PubMed  Google Scholar 

  19. Jansen Klomp WW, et al. Survival and quality of life after surgical aortic valve replacement in octogenarians. J Cardiothorac Surg. 2016;11:38.

    PubMed  PubMed Central  Google Scholar 

  20. Leon MB, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363(17):1597–607.

    CAS  PubMed  Google Scholar 

  21. Smith CR, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187–98.

    CAS  PubMed  Google Scholar 

  22. Leon MB, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374(17):1609–20.

    CAS  PubMed  Google Scholar 

  23. Mack MJ, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695–705.

    Google Scholar 

  24. Popma JJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706–15.

    Google Scholar 

  25. Carroll JD, et al. Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry. J Am Coll Cardiol. 2017;70(1):29–41.

    PubMed  Google Scholar 

  26. Weintraub WS. TAVR in nonagenarians: pushing the boundaries. J Am Coll Cardiol. 2016;67(12):1396–8.

    PubMed  PubMed Central  Google Scholar 

  27. Nkomo VT, et al. Burden of valvular heart diseases: a population-based study. Lancet. 2006;368(9540):1005–11.

    PubMed  Google Scholar 

  28. Mirabel M, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–65.

    PubMed  Google Scholar 

  29. Badhwar V, et al. Longitudinal outcome of isolated mitral repair in older patients: results from 14,604 procedures performed from 1991 to 2007. Ann Thorac Surg. 2012;94(6):1870–7; discussion 1877–9.

    PubMed  Google Scholar 

  30. Seeburger J, et al. Mitral valve surgical procedures in the elderly. Ann Thorac Surg. 2012;94(6):1999–2003.

    PubMed  Google Scholar 

  31. Nloga J, et al. Mitral valve surgery in octogenarians: should we fight for repair? A survival and quality-of-life assessment. Eur J Cardiothorac Surg. 2011;39(6):875–80.

    PubMed  Google Scholar 

  32. Seeburger J, et al. Minimally invasive mitral valve surgery in octogenarians-a brief report. Ann Cardiothorac Surg. 2013;2(6):765–7.

    PubMed  PubMed Central  Google Scholar 

  33. Feldman T, et al. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med. 2011;364(15):1395–406.

    CAS  PubMed  Google Scholar 

  34. Stone GW, et al. Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. 2018;379(24):2307–18.

    PubMed  Google Scholar 

  35. Kortlandt F, et al. Survival after MitraClip treatment compared to surgical and conservative treatment for high-surgical-risk patients with mitral regurgitation. Circ Cardiovasc Interv. 2018;11(6):e005985.

    PubMed  Google Scholar 

  36. Sorajja P, et al. Initial experience with commercial transcatheter mitral valve repair in the United States. J Am Coll Cardiol. 2016;67(10):1129–40.

    PubMed  Google Scholar 

  37. Lim DS, et al. Improved functional status and quality of life in prohibitive surgical risk patients with degenerative mitral regurgitation after transcatheter mitral valve repair. J Am Coll Cardiol. 2014;64(2):182–92.

    PubMed  Google Scholar 

  38. Nickenig G, et al. Percutaneous mitral valve edge-to-edge repair: in-hospital results and 1-year follow-up of 628 patients of the 2011–2012 Pilot European Sentinel Registry. J Am Coll Cardiol. 2014;64(9):875–84.

    PubMed  Google Scholar 

  39. Hiratzka LF, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121(13):e266–369.

    PubMed  Google Scholar 

  40. Peterss S, et al. Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off? Eur J Cardiothorac Surg. 2017;51(5):965–70.

    PubMed  Google Scholar 

  41. Erbel R, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.

    PubMed  Google Scholar 

  42. D’Agostino RS, et al. The Society of Thoracic Surgeons adult cardiac surgery database: 2016 update on outcomes and quality. Ann Thorac Surg. 2016;101(1):24–32.

    PubMed  Google Scholar 

  43. Geirsson A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg. 2007;32(2):255–62.

    PubMed  Google Scholar 

  44. Ghoreishi M, et al. Mitral valve surgery in elderly patients with mitral regurgitation: repair or replacement with tissue valve? Curr Opin Cardiol. 2013;28(2):164–9.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Division of Cradiothoracic Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA

    Joshua B. Goldberg

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  1. Joshua B. Goldberg
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Correspondence to Joshua B. Goldberg .

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Editors and Affiliations

  1. Department of Surgery, New York Medical College, School of Medicine and Westchester Medical Center Health Network, Valhalla, NY, USA

    Rifat Latifi

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Goldberg, J.B. (2020). Cardiac Surgery in the Elderly. In: Latifi, R. (eds) Surgical Decision Making in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-030-47963-3_13

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  • DOI: https://doi.org/10.1007/978-3-030-47963-3_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47962-6

  • Online ISBN: 978-3-030-47963-3

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