Abstract:
OBJECTIVE:The purpose of the present study was to examine resource utilization in octogenarians undergoing coronary artery bypass grafting (CABG) and compare it with usage in their younger cohorts at a tertiary care heart center. The resources examined were time to extubation, packed red blood cell transfusions, intensive care unit (ICU) length of stay (LOS), and preoperative and postoperative LOS. The study also examined differences in postoperative morbidity and mortality. DESIGN:Retrospective hospital follow-up study of consecutive patients undergoing CABG using a prospectively designed database. SETTING:University teaching tertiary care referral center for cardiac surgery. PARTICIPANTS:Seventeen hundred forty-six male and female patients undergoing CABG surgery, including 155 octogenarians and 1591 patients younger than 80 years. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Demographic, mortality, morbidity, and resource utilization data were collected from the records of patients undergoing CABG at the authors' institution over 3 years. There were 1746 patients: 155 octogenarians and 1591 nonoctogenarians. Octogenarians had a significantly higher incidence of preoperative stroke, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and left main disease. They weighed significantly less, and had lower preoperative and postoperative hematocrit. There was a significantly higher percentage of women in the octogenarian group. Mean time from the end of surgery to endotracheal extubation was 9.3 hours for octogenarians and 6.3 hours for their younger cohorts (p < 0.001). Blood transfusion was required in 88.4% of octogenarians compared with 58.6% of nonoctogenarians (p < 0.001). Mean ICU LOS was 1.9 days for octogenarians and 1.4 days for nonoctogenarians (p < 0.001). Mean postoperative LOS was 8.7 days for octogenarians and 5.8 days for nonoctogenarians (p < 0.001). Clinical and demographic variables were correlated with age 80 years or older. Multivariate linear and logistic regression models were constructed to show the combined effects of age and comorbid conditions on outcomes. Octogenarians had a significantly higher incidence of postoperative renal failure and neurologic complications. The 30-day mortality rate was 9.0% for the octogenarian group v 1.2% for the younger group (p < 0.001). Age 80 years or older was significantly associated with outcome, and was an independent predictor of increased resource utilization and postoperative mortality and morbidity. CONCLUSIONS:The results demonstrated that octogenarians undergoing CABG required increased resource utilization and had significantly higher morbidity, with increased incidence of postoperative renal failure, neurologic complications, and 30- day mortality. Age 80 years or older was an independent predictor of increased resource utilization, postoperative morbidity, and mortality.
journal_name
J Cardiothorac Vasc Anesthjournal_title
Journal of cardiothoracic and vascular anesthesiaauthors
Scott BH,Seifert FC,Grimson R,Glass PSdoi
10.1053/j.jvca.2005.03.030keywords:
subject
Has Abstractpub_date
2005-10-01 00:00:00pages
583-8issue
5eissn
1053-0770issn
1532-8422pii
S1053-0770(05)00143-6journal_volume
19pub_type
杂志文章abstract:STUDY OBJECTIVE:Cardiac surgery is complicated by decreased postoperative respiratory muscle strength and spirometry with accompanying increased atelectasis. The specific respiratory symptoms attributable to these physiologic changes are unknown, and this study looked at the symptoms and underlying physiology. DESIGN:...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(96)80130-3
更新日期:1996-08-01 00:00:00
abstract:OBJECTIVE:Right-sided heart failure develops in lung transplantation candidates on prolonged peripheral extracorporeal membrane oxygenation support and is a major determinant of mortality. The use of central venoarterial extracorporeal membrane oxygenation for bridging of right-sided heart failure to lung transplantati...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.01.059
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:The postoperative course following on-pump coronary artery bypass grafting (CABG) in patients with severe left ventricular (LV) systolic dysfunction is often unpredictable. Therefore, the aim of this study was to identify predictors of poor postoperative outcome in this subset of patients. DESIGN:Prospectiv...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2016.04.025
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:To characterize the impact, on failure to rescue, of cerebrovascular accident as a first postoperative complication after thoracic endovascular aortic aneurysm repair (TEVAR). DESIGN:A retrospective cohort study using of National Surgical Quality Improvement Program Participants User File. SETTING:United St...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.11.061
更新日期:2020-12-02 00:00:00
abstract::The incidence of primary cardiac tumors is very rare (0.02%) with the majority being benign. Angiosarcoma is the most common malignant cardiac tumor. However, regardless of the histological nature of cardiac tumors, they can cause life-threatening mechanical obstruction. We present a case of urgent surgical removal of...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.12.018
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:To evaluate the association of preoperative invasive hemodynamic parameters with mortality in valvular heart surgery. DESIGN:Retrospective cohort study. SETTING:Single tertiary academic medical center. PARTICIPANTS:A total of 382 patients who underwent preoperative right and/or left heart catheterization ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2017.09.041
更新日期:2018-06-01 00:00:00
abstract::This study examined the effects of global normothermic hypoperfusion on the compressed spectral array (CSA) processed electroencephalogram (EEG) during high-dose narcotic anesthesia. Fifteen patients undergoing cardiac electrophysiologic surgery were studied. The patients were anesthetized with a standard high-dose na...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(91)90276-y
更新日期:1991-06-01 00:00:00
abstract::Fiberoptic pulmonary artery flotation catheters have gained clinical acceptance for continuous monitoring of mixed venous oxygen saturation (SvO2), especially in the management of hemodynamically unstable patients. Therefore, the performance of the oximetry system used is extremely important. The accuracy and stabilit...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(92)90139-x
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVE:To assess the effect of systemic vascular resistance (SVR) on the reliability of the ClearSight system (Edwards Lifesciences, Irvine, CA) for measuring blood pressure (BP) and cardiac output (CO). DESIGN:Observational study. SETTING:University hospital. PARTICIPANTS:Twenty-five patients undergoing cardiac ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.11.011
更新日期:2020-11-12 00:00:00
abstract::Sixteen patients (aged 59 +/- 14 years) undergoing coronary artery bypass surgery were evaluated to delineate the intraoperative course of transesophageal echocardiographic right ventricular (RV) systolic performance indices. Pre-induction data included thermodilution RV ejection fraction (RVEFTD), 0.43 +/- 0.13, RV e...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(93)90210-c
更新日期:1993-04-01 00:00:00
abstract:OBJECTIVE:To determine whether postoperative forced-air warming of cardiac bypass patients in the intensive care unit (ICU) results in faster rate of warming and improved outcomes compared with more conventional ICU warming methods. DESIGN:Prospective randomized effectiveness study. SETTING:Three hundred fifty-bed un...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s1053-0770(97)90162-2
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVES:The use of monitored anesthesia care (MAC) for transcatheter aortic valve replacement (TAVR) is gaining favor in the United States, although general anesthesia (GA) continues to be common for these procedures. Open surgical cutdown for transfemoral TAVR has been a relative contraindication for TAVR with MAC ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.05.036
更新日期:2019-01-01 00:00:00
abstract:OBJECTIVE:To test the reproducibility of Sonoclot coagulation analysis (SCA; Sienco Inc, Morrison, CO). The authors wished to determine if the mix/release of the preloaded celite activator in standard Sono-cuvettes could be responsible for the high variation coefficients for SCA parameters with citrated whole blood and...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/s1053-0770(99)90209-4
更新日期:1999-08-01 00:00:00
abstract::Appropriate anesthesia for LVAD placement needs to incorporate an understanding of the surgical procedure and LVAD physiology, the altered physiology and pharmacology of the cardiac failure patient, and a knowledge of the interaction of anesthesia with the potent cardiac drugs used in end-stage heart failure therapy. ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:Mechanical stress during one-lung ventilation (OLV) results in lung injury. This study compared the effects of mechanical ventilation, OLV, and surgical manipulation on diffuse alveolar damage (DAD) after application of different anesthetic regimens. DESIGN:Prospective, randomized, controlled, blinded animal...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2009.09.016
更新日期:2010-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to investigate the association between general (GA), regional (RA), and local (LA) anesthetic techniques with respect to the development of delirium after vascular surgery. The authors hypothesized that patients undergoing GA for vascular surgery would have a higher incidence of ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2013.12.003
更新日期:2014-06-01 00:00:00
abstract::The vascular endothelium is intimately involved in a wide variety of normal physiological processes, including coagulation/anticoagulation, the maintenance of vascular tone, and pathological processes, including reperfusion injury, inflammatory syndromes, and tumor cell metastasis. This review discusses the importance...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1016/s1053-0770(97)90101-4
更新日期:1997-05-01 00:00:00
abstract:OBJECTIVE:To evaluate whether exogenous surfactant therapy may be useful in adult patients with acute lung injury or acute respiratory distress syndrome, using a meta-analysis of published clinical trials. DESIGN:A comprehensive literature search was performed to identify all randomized clinical trials examining the e...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,meta分析
doi:10.1053/j.jvca.2011.11.006
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to assess the feasibility and effects on perioperative management of a focused transthoracic echocardiogram performed by anesthesiologists. DESIGN:A prospective observational study of all patients having a focused cardiovascular ultrasound (FoCUS). SETTING:A single tertiary referr...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2009.01.018
更新日期:2009-08-01 00:00:00
abstract::Nine NYHA class III-IV patients awaiting heart transplantation (HTx) were studied with a right ventricular ejection fraction (RVEF) catheter. The first aim of the study was to explore the pulmonary and systemic circulatory effects of dobutamine (D) and/or nitroprusside (N) in these patients. The second aim was to sear...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/1053-0770(93)90013-b
更新日期:1993-06-01 00:00:00
abstract::Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light. Because NIRS provides instantaneous information on cerebral and somatic tissue oxygenation, it becomes mandatory to identify rapidly the etiology of impaired regional oxygenation and thus...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,评审
doi:10.1053/j.jvca.2019.03.039
更新日期:2019-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the prognostic implication of changes in postoperative B-type natriuretic peptide (BNP) concentrations in patients undergoing cardiopulmonary bypass for cardiac surgery. DESIGN:A retrospective analysis of prospectively collected clinical data. SETTING:Cardiothoracic surgery and an intensive care...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2010.07.002
更新日期:2011-06-01 00:00:00
abstract:OBJECTIVE:Two types of material are used to manufacture double-lumen endobronchial tubes (DLTs): Polyvinylchloride (PVC) and silicon. PVC DLTs (Broncho-Cath) and silicon DLTs (Silbroncho) not only differ in material, but also subtly differ in structure. The goal of this study was to determine whether the incidences of ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,随机对照试验
doi:10.1053/j.jvca.2014.05.028
更新日期:2015-02-01 00:00:00
abstract:OBJECTIVE:To delineate associations between preoperative risk factors and clinical processes of care and perioperative glucose tolerance in patients managed on a fast-track cardiac surgery clinical pathway with prebypass methylprednisolone administration. DESIGN:Retrospective sequential cohort study. SETTING:Universi...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/jcan.2000.18298
更新日期:2000-12-01 00:00:00
abstract:OBJECTIVE:Over 150,000 carotid endarterectomy (CEA) procedures are performed each year. Perioperative anesthetic management may be complex due to multiple patient and procedure-related risk factors. The authorsaimed to determine whether the use of general anesthesia (GA), when compared with regional anesthesia (RA), wo...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.08.195
更新日期:2019-04-01 00:00:00
abstract:OBJECTIVE:The actions of volatile anesthetics on left ventricular (LV) function in normal and failing hearts have been previously evaluated, but the effects of these agents on left atrial (LA) function in the presence of LV dysfunction are unknown. The hypothesis was tested that isoflurane alters LA mechanics evaluated...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2003.09.006
更新日期:2003-12-01 00:00:00
abstract::The efficacy of interpleural administration of sufentanil, 50 micrograms, was compared with that of 150 mg of bupivacaine, 0.5%, with epinephrine, 5 micrograms/mL, or saline, in 30 patients (N = 10 in each group) undergoing lateral thoracotomy. Sufentanil, bupivacaine, or saline was administered interpleurally after i...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1016/1053-0770(93)90307-7
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:The authors aimed to assess the hemodynamic effects and demonstrate the feasibility of inhaled nitric oxide (iNO) in hemodynamically unstable patients with acute right ventricular (RV) dysfunction and to explore the safety profile of this approach. DESIGN:Retrospective cohort study. SETTING:Intensive care u...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2018.08.004
更新日期:2019-03-01 00:00:00
abstract:OBJECTIVE:In minimally invasive surgical ablation for atrial fibrillation during video-assisted thoracoscopy surgery, one-lung ventilation (OLV) with a double- lumen tube is commonly employed. In contrast with the majority of thoracic procedures, the patient lies supine; thus, the protective effect of gravity is lost a...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章
doi:10.1053/j.jvca.2020.03.064
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVE:To investigate the risk factors for postoperative delirium and the impact of delirium on mortality and morbidity following transcatheter aortic valve implantation (TAVI). DESIGN:Patients who underwent TAVI were identified using the International Classification of Diseases, 9th revision clinical modification ...
journal_title:Journal of cardiothoracic and vascular anesthesia
pub_type: 杂志文章,多中心研究
doi:10.1053/j.jvca.2017.03.016
更新日期:2017-12-01 00:00:00