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 (Cпецвыпуск): 1-53 ➤ Периоперационные факторы риска хирургической коррекции клапанных пороков сердца и ишемической болезни сердца у пожилых пациентов

Perioperative risk factors for surgical correction of valvular heart disease and coronary heart disease in elderly patients

Authors: Pelekh D.M., Nikitina T.G., Vanichkin A.V., Filippkina T.Yu., Bockeria L.A., 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/10.24022/1810-0694-2023-24S2-S40-S54

UDC: [616.12-007.1+616.12-008.46]-053.9-089.163

Link: Clinical Physiology of Blood Circulaiton. 2023; Спецвыпуск (20): 38-53

Quote as: Pelekh D.M., Nikitina T.G., Vanichkin A.V., Filippkina T.Yu., Bockeria L.A., Golukhova E.Z. Perioperative risk factors for surgical correction of valvular heart disease and coronary heart disease in elderly patients. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2023; 24 (Special Issue 2) (in Russ.). DOI: 10.24022/1810-0694-2023-24S2-S40-S54

Keywords:  elderly patients valvular heart disease coronary artery disease cognitive status complications early period after surgery

Received / Accepted:  31.08.2023 / 02.10.2023

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Abstract

Objective. Comparative assessment of perioperative risk factors, including cognitive status, physiological reserve, comorbidity, during surgical correction of valvular heart disease (VHD) and coronary heart disease in elderly and middle- aged patients.

Material and methods. Сorrection of VHD in conditions of artificial circulation (AC) was performed in 240 elderly patients and 140 patients younger than 60 years (control group). The average EuroSCORE II was 15.7 ± 3.3% and 9.4 ± 4.5%, respectively. According to the SAGE questionnaire 46,5% of the elderly and 21,7% of patients of the control group had borderline to severe cognitive impairment. According to the EFI scale, the average score in the elderly was 7.5 ± 1.9, that is, patients on average were “vulnerable”, in patients of the control group – 4.7 ± 2.8, that is, most patients were “not frail” (p < 0.05). According to the CCI scale, the elderly were highly comorbid – the average score was 8.5 ± 1.1, and the patients in the control group had a moderate degree of comorbidity, the average score was 3.7 ± 5.3 points. The average AC time in the elderly was 146 ± 2.3 min, and in patients of the control group 138 ± 5.1 min.

Results. Complications in the early postoperative period were noted in 103 (42.9%) elderly and in 30 (21.4%) patients of the control group. At the same time, 4.2% of the elderly suffered from stroke in the early postoperative period. 1.7% of the elderly and 1.4% of patients younger than 60 years had postoperative delirium. It was noted that the reduced preoperative cognitive status, reduced physiological reserve and high comorbidity were the factors correlated with the development of postoperative delirium. In addition, the AC time more than 160 minutes was also an additional significant factor exacerbating the development of neurological deficits in the early postoperative period in all patients.

Conclusion. Preoperative low and severe cognitive dysfunction, frailty and high comorbidity became predictors of the development of postoperative delirium in elderly and control group patients. The risk of developing cognitive impairment in the early postoperative period in both the elderly and patients younger than 60 years was associated with a time of AC ≥ 160 min.

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About Authors

  • Dmitriy M. Pelekh, Cand. Med. Sci., Researcher, Cardiologist; ORCID
  • Tatyana G. Nikitina, Dr. Med. Sci., Professor, Chief Researcher of Department of Cardiosurgery of Acquired Heart Diseases; ORCID
  • Aleksey V. Vanichkin, Cand. Med. Sci., Neurologist at the Rehabilitation Center for Children; ORCID
  • Tatyana Yu. Filippkina, Cand. Phys. Math. Sci., Analyst of the 1st category of the Scientific Research Institute of Health Organization and Medical Management; ORCID
  • БLeo A. Bockeria, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, President of the Center; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Director; ORCID

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