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. 2022; 19 (4): 287-392 ➤ Прогностическое значение физиологического резерва у больных старческого возраста при коррекции клапанных пороков сердца

Prognostic value of physiological reserve in old-aged patients with correction of valvular heart disease

Authors: Pelekh D.M., Nikitina T.G., Gulyan K.S., 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/10.24022/1814-6910-2022-19-4-314-325

UDC: 616.126.3-053.9-089

Link: Clinical Physiology of Blood Circulaiton. 2022; 4 (19): 314-325

Quote as: Pelekh D.M., Nikitina T.G., Gulyan K.S., Filippkina T.Yu., Bockeria L.A., Golukhova E.Z. Prognostic value of physiological reserve in old-aged patients with correction of valvular heart disease. Clinical Physiology of Circulation. 2022; 19 (4): 314–25 (in Russ.). DOI: 10.24022/1814-6910-2022-19-4-314-325

Keywords:  old-aged patients valvular heart disease ± coronary artery disease early postoperative complications hospital mortality physiological reserve comorbidity predictors

Received / Accepted:  30.10.2022 / 21.12.2022

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Abstract

Objective. To analyze the physiological reserve in elderly patients (≥ 75 years) before the correction of valvular heart disease with or without coronary artery disease (VHD ± CAD) and to evaluate the impact of low physiological reserve on the course of the early postoperative (p/o) period.

Material and methods. Correction of VHD ± CAD was performed in 140 patients ≥ 75 years old, mean age 77.2 ± 2.1 years. The mean score on the Edmonton Physiological Frail Index (EFI) in patients ≥ 75 years old was 8.8 ±1.9 (“middle frail”). “Not frail” were 27.1% of patients, 72.9% – from “vulnerable” to “severe frail” (10.8% – “severe frail”). The mean score for the M. Charlson comorbidity index (CCI) was 9.5 ± 4.2. Before correction of the defect, 77 (55%) patients were in the III functional class (FC) according to the classification New York Heart Association (NYHA), 63 (45%) – in the IV FC. The mean EuroSCORE II (ES II) in patients ≥ 75 years old is 20.7 ±1.3%. Operations were performed: correction of 1 valve defect of – in 61 (43.6%) patients, 2 valves – in 38 (27.1%). Combined operations (correction of VHD ± CAD) were performed in 33 (23.6%) patients, staged treatment (stage I – percutaneous coronary intervention, stage II – correction of VHD) – in 8 (5.7%) patients. The mean time of artificial circulation was 152 ± 4.1 min, the mean time of aortic clamping was 61 ± 4.8 min, the mean time of artificial lung ventilation was 42.6 ± 5.3 hours. The average duration of treatment in the intensive care unit was 6.3 ± 1.5 days. The average length of stay in the clinic was 15.7 ± 4.0 days.

Results. Non-lethal complications in the early postoperative period were diagnosed in 58 (41.4%) patients: acute heart failure (AHF) – in 16 (11.4%), heart arrhythmia (HA) (atrial fibrillation, atrioventricular blockade II–III stage, ventricular tachycardia) – in 14 (10%), pneumonia – in 10 (7.1%), multiple organ failure syndrome – in 7 (5%), bleeding – in 7 (5%), stroke – in 4 (2.9%). Hospital mortality was 9.3% (n =13): AHF – 6, pneumonia – 4, stroke – 2, pulmonary embolism – 1. According to the logistic regression data, it was noted that IV FC before operations (b/o) (p = 0.001), CCI ≥ 3 (p = 0.003) and ES II ≥ 5% (p = 0.04), as well as EFI “middle frail” – “severe frail” had a strong influence on the development of AHF in the early postoperative period in patients ≥ 75 years (p = 0.05). The predictors of the development of HA were: age ≥ 75 years (p = 0.002), CCI ≥ 3 (p = 0.013), ES II ≥ 5% (p = 0.03) and EFI “middle frail” – “severe frail” (p = 0.05). The analysis of hospital mortality showed that the predictors of mortality from AHF were: IV FC b/o (p = 0.003), CCI ≥ 3 (p = 0.005), ES II ≥ 5% (p = 0.01), EFI “middle frail” – “severe frail” (p = 0.03) and age ≥ 75 years (p = 0.03). In addition, age ≥ 75 years (p = 0.031) and CCI ≥ 3 (p = 0.035) were predictors of pneumonia mortality. At discharge, 98 (77.2%) patients were in NYHA FC II, and 29 (22.8%) patients were in FC III. 11 (14.3%) patients, who were b/o in FC III, remained in FC III upon discharge from the clinic. The average age in this subgroup was 79.5 ±1.5 years, the average EFI was 12.1 ± 2.4 (“moderate frail”), the average ES II was 21.8 ±1.7%, and all patients had a complicated during the p/o period.

Conclusion. Before correction of VHD ± CAD, 72.9% of patients were EFI-scored from “vulnerable” to “worn-out”. A low physiological reserve became a predictor of the development of postoperative AHF and HA in the early p/o period. In addition, the low reserve had an impact on the development of mortality from AHF in the early postoperative period. 11 (14.3%) patients who were b/o in FC III remained in FC III at discharge, and the analysis showed that these patients b/o were older (79.5 ±1.5 years), were highly comorbid (mean CCI – 12.8 ±1.7), had a lower physiological reserve (mean EFI – 12.1 ± 2.4, "moderate frail"), the average ES II was 21.8 ± 1.7%, and all patients had a complicated p/o period.

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****
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About Authors

  • Dmitriy M. Pelekh, Cand. Med. Sci., Researcher, Cardiologist; ORCID
  • Tat'yana G. Nikitina, Dr. Med. Sci., Professor, Leading Researcher; ORCID
  • Knar S. Gulyan, Cand. Med. Sci., Cardiologist; ORCID
  • Tat'yana Yu. Filippkina, Cand. Phys.-Math. Sci., Analyst
  • Leo A. Bockeria, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, President; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of Russian Academy of Sciences, Director; ORCID

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