Clinical Physiology of Circulation

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


Evaluation of comorbidity in elderly patients before correction of valvular heart diseases

Authors: Pelekh D.M., Nikitina T.G., Gulyan K.S., Fadeev A.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/10.24022/1814-6910-2021-18-4-281-290

UDC: 616.126-089-008.6

Link: Clinical Physiology of Blood Circulaiton. 2021; 4 (18): 281-290

Quote as: Pelekh D.M., Nikitina T.G., Gulyan K.S., Fadeev A.A., Golukhova E.Z. Evaluation of comorbidity in elderly patients before correction of valvular heart diseases. Clinical Physiology of Circulation. 2021; 18 (4): 281–90 (in Russ.). DOI: 10.24022/1814-6910-2021-18-4-281-290

Received / Accepted:  23.08.2021 / 28.09.2021

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Abstract

Objective. To conduct a preoperative assessment of comorbidity in elderly patients before correction of valvular heart disease (VHD) in conditions of artificial circulation.

Material and methods. 310 patients with VHD were assessed for the level of comorbidity using the Charlson Comorbidity Index (CCI). The patients were divided into 2 groups: 200 patients ≥ 60 years old (group I elderly, average age 66.3 ± 2.7 years) and 110 patients < 60 years (control group II, average age 56.3 ± 1.8 years). In group I, patients before surgery were assigned to functional class (FC) III 61.4% and IV FC 38.6% according to New-Yorks’ Heart Association (NYHA). The average EuroSCORE II (ES II) in the elderly is 18.2 ± 6.4%. In group II, FC III according to NYHA was assigned to 66.1%, to FC IV – 33.9% of patients. Average ES II in group II was 9.2 ± 1.1%. 23.1% of patients in group I and 31.1% of patients in group II underwent combined operations (correction VHD + coronary artery bypass graft).

Results. The mean CCI score in the elderly group was 5.7 ± 2.2, patients had ≥ 3 concomitant diseases: 100% had hypertension (blood pressure (BP) ≥ 140/90 mm Hg), 36% – ischemic heart disease (coronary artery disease – stenosis of the coronary arteries ≥ 65%), 21% – chronic kidney disease 3 degree (CKD grade 3 with GFR ≤ 50 ml/min/m2). In group II, the average score on the CCI questionnaire was 2.7 ± 1.5. 88% of patients had hypertension, 35.5% had coronary artery disease, 10.5% had CKD grade 3. Hospital mortality in group I – 6.5%, in group II – 2.7%. Predictors of hospital mortality in both groups: CCI ≥ 5 (OR = 1.1; p = 0.023), ES II ≥ 8% (OR = 1.4; p = 0.06), combined surgery (OR = 2.8; p = 0.017).

Conclusion. Evaluation of comorbidity is an important and independent element of risk stratification for surgical treatment of VHD under cardiopulmonary bypass in elderly patients with an initially high ES II (≥ 5%). According to our study, a high CCI score (≥ 3–6) is a predictor of the development of postoperative (p/o) complications and mortality in the early stages of p/o (up to 30 days after operation).

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About Authors

  • Dmitriy M. Pelekh, Cand. Med. Sci., Researcher, Cardiologist; ORCID
  • Tat’yana G. Nikitina, Dr. Med. Sci., Professor, Head of Department of Cardiology of Acquired Heart Diseases; ORCID
  • Knar S. Gulyan, Cand. Med. Sci., Cardiologist; ORCID
  • Aleksandr A. Fadeev, Cand. Tech. Sci., Head of Laboratory for the Application of Polymers in Cardiovascular Surgery; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Director; ORCID

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