Clinical Physiology of Circulation

ISSN 1814-6910 (Print)
ISSN 2410-9134 (Online)

 

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Issue's catalogue ➤ КФК. 2023; 20 (1): 1-88 ➤ Анализ осложнений у пациентов старческого возраста в среднеотдаленные сроки после коррекции клапанных пороков сердца

Analysis of complications in the oldaged patients in the medium-long term after the correction of valvular heart diseases

Authors: Pelekh D.M., Nikitina T.G., Gulyan K.S., Filippkina T.Yu., Golukhova E.Z.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2023-20-1-24-37

UDC: 616.124.2:612.13]-089.168.1

Link: Clinical Physiology of Blood Circulaiton. 2023; 1 (20): 24-37

Quote as: Pelekh D.M., Nikitina T.G., Gulyan K.S., Filippkina T.Yu., Golukhova E.Z. Analysis of complications in the oldaged patients in the medium-long term after the correction of valvular heart diseases. Clinical Physiology of Circulation. 2023; 20 (1): 24–37 (in Russ.). DOI: 10.24022/1814-6910-2023-20-1-24-37

Keywords:  patients ≥ 75 years old valvular heart defects±coronary artery diseases medium-long-term postoperative periods combined operations survival rate complications physiological reserve comorbidity

Received / Accepted:  12.01.2023 / 07.03.2023

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Abstract

Objective. To analyze complications in the medium-term within 6 months – 3 years after operations (the average followup period is 38.5 ± 4.1 months) after the correction of valvular heart diseases with/without coronary artery disease (VHD ± CAD) in old-aged patients (≥ 75 years old), assessing the effect of low physiological reserve and high comorbidity on the development of complications.

Material and methods. From January 2019 to December 2021, 140 patients of ≥ 75 years old, the average age 77.2 ± 2.1 years, underwent the correction of VHA ± CAD. The average score of the Edmonton frail scale/index (EFI) before operations was 8.8±1.9 (“middle frail”) (27.1% of patients were “not frail”, 72.8% – from “vulnerable” to “severe frail” (10.7% – “severe frail”)). The average score on the M. Charlson comorbid index (CCI) in the patients ≥ 75 years old was 9.5 ± 4.2. Before the correction of the disease, 77 (55%) patients were in the III functional class (FC) of heart failure according to the New York Heart Association (NYHA); 63 (45%) – in the IV FC. The average EuroSCORE (ES) II in the ≥ 75 years old patients was 12.7 ± 3.3%. The majority (43.6%) of patients underwent single-valve correction, combined operations (VHD±coronary artery bypass grafting (CABG)) were performed in 23.6% of the patients, and stage-by-stage treatment (stage I – percutaneous coronary intervention, stage II – correction of the VHD) – in 5.7% of the patients. Non-lethal complications in the early postoperative period were diagnosed in 41.4% of the patients: acute heart failure (AHF) – in 11.4%, cardiac arrhythmias (CA) – in 10%, pneumonia – in 7.1%, multiple organ failure syndrome – in 5%, bleeding – in 5%, stroke – in 2.9% of the patients. Hospital mortality was 9.3% (n = 13): AHF – 6, pneumonia – 4, stroke – 2, pulmonary embolism – 1. 127 of the patients were discharged from the clinic: 77.2% – in II FC, 22.8% – in III FC.

Results. Within 6 months – 3 years after the surgery, 18 (14.2%) of the patients died: complications of COVID-19 – 8, oncopathology – 3, HF – 2, stroke – 2, late prosthetic endocarditis – 1, Alzheimer's disease – 1, accident – 1 (excluding COVID-19 – 7.9%). The survival rate of within 6 months – 3 years after the operations was 87.5%. Predictors of reduced survival were: III FC after discharge from the clinic (p = 0.004), left ventricular ejection fraction < 35% before the surgery (p = 0.013), ES II ≥ 8% before the surgery (p = 0.016), low physiological reserve (EFI – “severe frail”) (p = 0.022) and extremely high comorbidity (CCI ≥ 8) (p = 0.026). In 51 (49.1%) of the ≥ 75 years of age patients, complications were diagnosed in the medium-long term: CA – in 22 (21.3%), transient ischemic attack (TIA) / stroke – in 15 (14.4%), the return of the angina clinic after combined and staged operations – in 12 (11.5%), paraprosthetic fistula (PPF) – in 1 patient and bleeding – in 1 patient. It should be noted that in 41.3% of patients ≥ 75 years of age, non-target values of the international normalized ratio were noted (< 2.5 after of aortic valve prosthetics, < 3.0 after of mitral valve prosthetics). According to EFI, a significant increase in the number of “not frail” patients ≥ 75 years old was observed in the medium-long-term period after the operations – 49.1% (p < 0.05): of the 15 “severe frail” patients, 8 patients died in the early postoperative period, and 4 – within 6–24 months after the surgery, 2 “severe frail” patients moved into the “middle frail” category, and 1 – into “moderate frail”. Average EFI value within 6 months – 3 years after operations – 7.1 ± 2.6 (“middle frail”). Low physiological reserve (EFI – “middle frail” – “moderate frail”), high comorbidity (CCI ≥ 3 and ≥ 8), and ES II ≥ 8% were reliable predictors of the development of CA, stroke, the return of the angina pectoris clinic within 6 months – 3 years after operations. The age ≥ 75 years old was a predictor of the development of only stroke transient ischemic attack in the medium-long term after correction of the VHD ± CAD. The majority (72.5%) of the patients in the medium-long term were in the II FC, therefore the result of surgical correction of the VHD ± CAD was regarded as a good, satisfactory result of the operation was noted in 27.5% of the ≥ 75 years old patients (the patients in the III FC). The patients who in the III FC within 6 months – 3 years after the operations had a low physiological reserve (EFI – “middle frail” – “moderate frail”), were highly comorbid, and all patients had the complications (CA, stroke, angina pectoris clinic, PPF).

Conclusion. Taking into account the increase in the number of operations to correct VHD ± CAD in old patients, conducting a comprehensive assessment of risk factors for cardiac surgery with an assessment of physiological reserve and comorbidity both before surgery and in the medium-long term after correction of VHD will allow to assess the risk of treatment in each ≥ 75 years old patient, which will improve the results of treatment in this a complex category of patients.

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About Authors

  • Dmitriy M. Pelekh, Cand. Med. Sci., Researcher; ORCID
  • Tatyana G. Nikitina, Dr. Med. Sci., Professor, Chief Researcher; ORCID
  • Knar S. Gulyan, Cand. Med. Sci., Cardiologist; ; ORCID
  • Tatyana Yu. Filippkina, Cand. Phys.-Math. Sci., Analyst
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Director; ORCID

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