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. 2021; 18 (1): 1-92 ➤ Оценка психофизиологического резерва у пожилых пациентов перед операцией в условиях искусственного кровообращения

Assessment of the psychophysiological reserve in elderly patients before surgery under artificial circulation

Authors: Nikitina T.G., Pelekh D.M., Golukhova E.Z.

Company:
Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

DOI: https://doi.org/10.24022/1814-6910-2021-18-1-73-8

UDC: 616.126-007-053.9:612.82

Link: Clinical Physiology of Blood Circulaiton. 2021; 1 (18): 73-83

Quote as: Nikitina T.G., Pelekh D.M., Golukhova E.Z. Assessment of the psychophysiological reserve in elderly patients before surgery under artificial circulation. Clinical Physiology of Circulation. 2021; 18 (1): 73–83 (in Russ.). DOI: 10.24022/1814-6910-2021-18-1-73-83

Keywords:  elderly patients artificial circulation valvular heart disease psychophysiological reserve comorbidity cognitive impairmen

Received / Accepted:  12.01.2021 / 14.01.2021

Full text:  

Abstract

Objective: To analyze the EFI, CCI, SF-36 and SAGE questionnaires of elderly patients (≥ 60 years) with valvular heart disease (VHD) before surgical valve defects correction in order to assess the psychophysiological status.

Material and methods. In the Department of Cardiosurgery of Acquired Heart Diseases of the Bakoulev Center from January 2019 to June 2020 118 surgical VHD corrections in patients ≥ 60 years old were performed. The average age was 66 ± 3 years (60.2–74.9 years). 67 (56.8%) patients – in FC III according to NYHA, 51 (43.2%) – in IV FC. The average value of EuroSCORE II was 22.5 ± 1.6% (2.2–43.1%). The average artificial circulation time was 135 ± 2 minutes, the aortic clamping time was 41 ± 7.4 minutes. Hospital mortality was 7.6%. Before surgery, 118 patients underwent an assessment of their psychophysiological state using the EFI, CCI, SF-36 and SAGE questionnaires.

Results. The average score according to the EFI questionnaire was 8.9 ± 3.2, indicating that most of the patients (67%) admitted for VHD surgical treatment were vulnerable, mild frail, moderate frail and frail. Analyzing the results of the CCI questionnaire, we obtained an average score of 5 ± 3.6, which meant that, patients had ≥3 concomitant diseases and the 10-year life expectancy was 53%. According to the SF-36 questionnaire, a low quality of life was noted in terms of characteristics: physical functioning (44.3 ± 10.3), physical pain (50.9 ± 1.1), general health (56.3 ± 7.2). According to SAGE, 57.3% of our patients had no cognitive impairment.

Conclusion. The analysis of the EFI, CCI, SF-36, and SAGE questionnaires in 118 elderly patients showed that patients (67%) admitted for surgical treatment of VHD were vulnerable, mid frail, moderate frail, and frail and had a low quality of life and were highly comorbid. A multidisciplinary approach is needed in the selection and management of elderly patients before and after surgery with artificial circulation.

References

  1. Fried L.P., Tangen C.M., Walston J., Newman A.B., Hirsch C., Gottdiener J. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. Series A. 2001; 56 (Is. 3): M146–57. DOI: 10.1093/gerona/56.3.m146
  2. Rowe R., Iqbal J., Murali-Krishnan R., Sultan A., Orme R., Briffa N. et al. Role of frailty assessment in patients undergoing cardiac interventions. Open Heart. 2014; 1 (1): e000033. DOI: 10.1136/openhrt-2013-000033
  3. Далинин В.В., Борисов И.А. Прогностическая значимость понятия «дряхлость» в кардиохирургии. Кардиология и сердечно-сосудистая хирургия. 2018; 11 (5): 82–5. DOI: 10.17116/kardio20181105182
  4. Lee D.H., Buth K.J., Martin B.J., Yip A.M., Hirsch G.M. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973–8.
  5. Matsuzawa Y., Konishi M., Akiyama E., Suzuki H., Nakayama N., Kiyokuni M. et al. Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction. J. Am. Coll. Cardiol. 2013; 61: 1964–72.
  6. Шихвердиев Н.Н., Ушаков Д.И., Пелешок А.С., Кривопалов В.А., Cизенко В.В. Биологический возраст и его роль в стратификации кардиохирургического риска. Вестник хирургии имени И.И. Грекова. 2019; 178 (1): 17–20. DOI: 10.24884/0042-4625- 2019-178-1-17-20
  7. Charlson M.E., Charlson R.E., Marinopoulos S.S., Briggs W.M., Hollenberg J.P. The Charlson Comorbidity Index is adapted to predict costs of chronic disease in primary care patients. J. Clin. Epidemiol. 2008; 61: 34–40. DOI: 10.1016/j.jclinepi.2008.01.006
  8. Tully P.J. Quality-of-life measures for cardiac surgery practice and research: a review and primer. J. ExtraCorporeal. Technol. 2013; 45: 8–15. DOI: 10.4236/ ojanes.2013.55020
  9. Гёлецян Л.Г., Никитина Т.Г., Лобачёва Г.В., Муратов Р.М., Скопин И.И. Госпитальная летальность у пожилых больных при коррекции пороков сердца. Клиническая физиология кровообращения. 2011; 2: 56–60.
  10. Масалина О.Е., Никитина Т.Г., Бокерия Л.А. Отдаленные результаты и качество жизни пациентов пожилого возраста после хирургического лечения приобретенных пороков сердца. Сердечно-сосудистые заболевания. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. 2010; 11 (2): 15–22.
  11. Clarke Ch., Wolverson E. Positive psychology approaches to dementia. Dementia. 2018; 17 (Is. 1): 127–9. DOI: 10.1177/1471301217739728
  12. Laurin D., Masaki K.H., White L.R., Launer L.J. Ankle-to-brachial index and dementia: the HonoluluAsia Aging Study. Circulation. 2015; 116: 2269–74. DOI: 10.1161/CIRCULATIONAHA.106.6864772
  13. Семенова Е.И., Железнев С.И., Семенов И.И., Назаров В.М., Астапов Д.А. Протезирование клапанов сердца у больных пожилого возраста. Сибирский медицинский журнал. 2007; 22 (3): 97–100.
  14. Искендеров Б.Г., Сисина О.Н. Частота и предикторы острого повреждения почек у больных, подвергнутых коррекции клапанных пороков сердца. Клиническая нефрология. 2013; 4: 21–4.
  15. UK Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing risk of both macrovascular and microvascular complications in type 2 diabetes (UKPDS 39). Br. Med. J. (BMJ). 1998; 317: 713–20.
  16. Голухова Е.З., Магомедова Н.М., Чеботарева Г.Е. Сравнительный анализ динамики гликемии при операциях реваскуляризации миокарда в условиях искусственного кровообращения и на работающем сердце с использованием систем непрерывного мониторирования глюкозы. Сахарный диабет. 2016; 19 (1): 44–52. DOI: 10.14341/DM7710
  17. Garcia-Donaire J.A., Ruilope L.M. Cardiovascularrenal connections in the cardiorenal continuum. Nephrology. 2013; 17 (1): 11–41. DOI: 14.15888
  18. Shaheen M., Puri1 S., Tandon N. Physical activity measurement in elderly: the Indian scenario. J. Physial. Activ. Res. 2016; 1 (1): 9–14. DOI: 10.12691
  19. Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged ≥80 years. Eur. J. Cardiothorac. Surg. 2006; 30: 722–7. 20. McKhann G.M., Grega M.A., Borowicz L.M. Jr., Bechamps M., Selnes O.A., Baumgartner W.A., Royall R.M. Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction. Arch. Neurol. 2002; 59 (9): 1422–8.
  20. Бокерия Л.А., Голухова Е.З., Полунина А.Г., Лефтерова Н.П., Бегачёв А.В. Когнитивные функции после операций с искусственным кровообращением в раннем и отдалённом послеоперационном периоде. Креативная кардиология. 2011; 2: 71–88.
  21. Van Rijen E.H.M., Utens E.M.W.J., Roos-Hesselink J.W., Meijboom F.J., Van Domburg R.T., Roelandt J.R.T.C. et al. Medical predictors for psychopathology in adults with operated congenital heart disease. Eur. Heart J. 2004; 25: 1605–13.
  22. Sundt T.M., Bailey M.S., Moon M.R., Mendeloff E.N., Huddelston C.B., Pasque M.K. Quality of life after aortic valve replacement at the age of > 80 years. Circulation. 2000; 102: III70–4.
****
  1. Fried L.P., Tangen C.M., Walston J., Newman A.B., Hirsch C., Gottdiener J. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. Series A. 2001; 56 (Is. 3): M146–57. DOI: 10.1093/gerona/56.3.m146
  2. Rowe R., Iqbal J., Murali-Krishnan R., Sultan A., Orme R., Briffa N. et al. Role of frailty assessment in patients undergoing cardiac interventions. Open Heart. 2014; 1 (1): e000033. DOI: 10.1136/openhrt-2013-000033
  3. Dalinin V.V., Borisov I.A. The prognostic significance of the concept of "decrepitude" in cardiac surgery. Cardiology and Cardiovascular Surgery. 2018; 11 (5): 82–5 (in Russ.). DOI: 10.17116/kardio20181105182
  4. Lee D.H., Buth K.J., Martin B.J., Yip A.M., Hirsch G.M. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973–8.
  5. Matsuzawa Y., Konishi M., Akiyama E., Suzuki H., Nakayama N., Kiyokuni M. et al. Association between gait speed as a measure of frailty and risk of cardiovascular events after myocardial infarction. J. Am. Coll. Cardiol. 2013; 61: 1964–72.
  6. Shikhverdiev N.N., Ushakov D.I., Peleshok A.S., Krivopalov V.A., Sizenko V.V. Biological age and its role in stratification of cardiac surgery risk. Grekov’s Bulletin of Surgery. 2019; 178 (1): 17–20 (in Russ.). DOI: 10.24884/0042-4625-2019-178-1-17-20
  7. Charlson M.E., Charlson R.E., Marinopoulos S.S., Briggs W.M., Hollenberg J.P. The Charlson Comorbidity Index is adapted to predict costs of chronic disease in primary care patients. J. Clin. Epidemiol. 2008; 61: 34–40. DOI: 10.1016/j.jclinepi.2008.01.006
  8. Tully P.J. Quality-of-life measures for cardiac surgery practice and research: a review and primer. J. ExtraCorporeal. Technol. 2013; 45: 8–15. DOI: 10.4236/ ojanes.2013.55020
  9. Geletsyan L.G., Nikitina T.G., Lobacheva G.V., Muratov R.M., Skopin I.I. Hospital mortality in elderly patients with the correction of heart defects. Clinical Physiology of Circulation. 2011; 2: 56–60 (in Russ.).
  10. Masalina O.E., Nikitina T.G., Bockeria L.A. Longterm results and quality of life of elderly patients after surgical treatment of acquired heart defects. Bulletin of Bakoulev Center. Cardiovascular Diseases. 2010; 11 (2): 15–22 (in Russ.).
  11. Clarke Ch., Wolverson E. Positive psychology approaches to dementia. Dementia. 2018; 17 (Is. 1): 127–9. DOI: 10.1177/1471301217739728
  12. Laurin D., Masaki K.H., White L.R., Launer L.J. Ankle-to-brachial index and dementia: the HonoluluAsia Aging Study. Circulation. 2015; 116: 2269–74. DOI: 10.1161/CIRCULATIONAHA.106.6864772
  13. Semenova E.I., Zheleznev S.I., Semenov I.I., Nazarov V.M., Astapov D.A. Prosthetics of heart valves in elderly patients. Siberian Scientific Medical Journal. 2007; 3: 97–100 (in Russ.).
  14. Iskenderov B.G., Sisina O.N. Prognostic value of the chronic kidney disease in the patients undergoing correction of valve heart disease. Clinical Nephrology. 2013; 4: 21–4 (in Russ.).
  15. UK Prospective Diabetes Study Group: Efficacy of atenolol and captopril in reducing risk of both macrovascular and microvascular complications in type 2 diabetes (UKPDS 39). Br. Med. J. (BMJ). 1998; 317: 713–20.
  16. Golukhova E.Z., Magomedova N.M., Chebotareva G.E. A comparative analysis of the dynamics of glycemia during myocardial revascularization operations under extracorporeal circulation and on a working heart using continuous glucose monitoring systems. Diabetes Mellitus. 2016; 19 (1) 44–52 (in Russ.). DOI: 10.14341/DM7710
  17. Garcia-Donaire J.A., Ruilope L.M. Cardiovascularrenal connections in the cardiorenal continuum. Nephrology. 2013; 17 (1): 11–41. DOI: 14.15888
  18. Shaheen M., Puri1 S., Tandon N. Physical activity measurement in elderly: the Indian scenario. J. Physial. Activ. Res. 2016; 1 (1): 9–14. DOI: 10.12691
  19. Varadarajan P., Kapoor N., Bansal R.C., Pai R.G. Survival in elderly patients with severe aortic stenosis is dramatically improved by aortic valve replacement: results from a cohort of 277 patients aged ≥80 years. Eur. J. Cardiothorac. Surg. 2006; 30: 722–7. 20. McKhann G.M., Grega M.A., Borowicz L.M. Jr., Bechamps M., Selnes O.A., Baumgartner W.A., Royall R.M. Encephalopathy and stroke after coronary artery bypass grafting: incidence, consequences, and prediction. Arch. Neurol. 2002; 59 (9): 1422–8.
  20. Bockeria L.A., Golukhova E.Z., Polunina A.G., Lefterova N.P., Begachev A.V. Cognitive functions after heart-lung surgery in the early and late postoperative periods. Creative Cardiology. 2011; 2: 71– 88 (in Russ.).
  21. Van Rijen E.H.M., Utens E.M.W.J., Roos-Hesselink J.W., Meijboom F.J., Van Domburg R.T., Roelandt J.R.T.C. et al. Medical predictors for psychopathology in adults with operated congenital heart disease. Eur. Heart J. 2004; 25: 1605–13.
  22. Sundt T.M., Bailey M.S., Moon M.R., Mendeloff E.N., Huddelston C.B., Pasque M.K. Quality of life after aortic valve replacement at the age of > 80 years. Circulation. 2000; 102: III70–4.

About Authors

  • Tat’yana G. Nikitina, Dr. Med. Sc., Professor, Head of Department of Cardiology of Acquired Heat Defects; ORCID
  • Dmitriy M. Pelekh, Cand. Med. Sc., Researcher, Cardiologist; ORCID
  • Elena Z. Golukhova, Dr. Med. Sc., Professor, Academician of RAS, Director; ORCID

 If you found mistakes, select text and press Alt+A