Elisabetta Rauber

Early and Late Outcomes of Cardiac Surgery in Octogenarians

BACKGROUND Expanding demand for cardiac surgery in the elderly requires constant assessment of selection criteria and outcomes. METHODS Records of consecutive patients 80 years old or greater (n = 355) having cardiac operations from September 1998 through May 2007 were reviewed. There were 172 isolated coronary bypass grafting (CABG), 73 isolated valve, 79 valve and CABG combined, and 31 other procedures. RESULTS Thirty-three (9.3%) deaths and 13 (3.7%) strokes occurred during the index hospital stay. Intensive care unit and hospital length of stay lasted 6.3 +/- 14.3 and 15.5 +/- 20.8 days, respectively. Overall cumulative 5-year survival was 65.5 +/- 3.3%, varying among procedures as follows: 67.9 +/- 4.4% for isolated CABG, 64.6 +/- 8.9% for valve surgery, 60.3 +/- 7.3% for combined coronary and valve surgery, and 63 +/- 10.7% for other procedures (p = 0.23). Ninety-seven percent of survivors lived at home. Risk factors for hospital death were emergency status, preoperative renal dysfunction, and postoperative complications such as myocardial infarction, cardiac failure requiring intraaortic balloon pumping, acute renal failure requiring replacement therapy, stroke, and ventilator dependency exceeding 48 hours. Among hospital survivors, risk factors for late death were carotid artery disease, chronic lung disease, renal dysfunction, and the occurrence of postoperative complications. CONCLUSIONS Long-term survival of octogenarians submitted to a wide variety of cardiac operations was satisfactory despite substantial rates of early complications and deaths. Most survivors were free from cardiac symptoms. Postoperative complications were stronger risk factors for hospital deaths than preoperative comorbidities and procedural variables. Their impact on long-term survival was also significant.

Liberal bilateral internal thoracic artery use in people with diabetes neutralizes the negative impact of insulin-requiring status

Aims Bilateral internal thoracic artery (BITA) grafts are underused in insulin-dependent diabetic patients because of increased risk of postoperative complications. The impact of the insulin-requiring status on outcomes after routine BITA grafting was investigated in this retrospective study. Methods Skeletonized BITA grafts were used in 3228 (71.6%) of 4508 consecutive patients having multivessel coronary disease who underwent isolated coronary bypass surgery at the authors’ institution from January 1999 to August 2015. Among these BITA patients, diabetes mellitus and the insulin-requiring status were present in 972 (30.1%) and 237 (7.3%) cases, respectively. After the one-to-one propensity score-matching, 215 pairs of insulin-dependent/noninsulin-dependent people with diabetes were compared as the postoperative outcomes. The operative risk was calculated for each patient according to the logistic European System for Cardiac Operative Risk Evaluation (logistic EuroSCORE). Results As expected, insulin-dependent people with diabetes had higher risk profiles than noninsulin-dependent people with diabetes (median logistic EuroSCORE, 4.1 vs. 3.5%, P = 0.086). However, there were no differences in in-hospital mortality both in unmatched and propensity score-matched series (2.5 vs. 2%, P = 0.65 and 2.8 vs. 1.9%, P = 0.52, respectively). In propensity score-matched pairs, only prolonged invasive ventilation (P = 0.0039) and deep sternal wound infection (P = 0.071) were more frequent in insulin-dependent people with diabetes. No differences were found as the late outcomes. Conclusion In diabetic patients, the insulin-requiring status is by itself a risk factor neither for in-hospital death nor for poor late outcomes after routine BITA grafting. Only the risk of prolonged invasive ventilation and deep sternal wound infection are increased early after surgery.

Disseminated echinococcosis: Follow your heart

: In this report, we present a rare case of cardiac echinococcosis presenting with cerebral haemorrhage due to rupture of a mycotic aneurysm in a peripheral branch of the media cerebral artery. Further investigations lead to discovery of multiple cysts in the heart and liver. The complementary use of transthoracic and transoesophageal echocardiography, MRI and computed tomography lead to the final diagnosis of disseminated echinococcosis and allowed precise evaluation of the anatomical and structural characteristics of the cardiac mass, its boundaries and its relationship with the surrounding anatomic structures.