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


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

Received / Accepted:  30.10.2022 / 21.12.2022

Full text:  

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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  4. Rolfson D., Majumdar S., Tsuyuki R., Tahir A., Rockwoodet K. Validity and reliability of the Edmonton Frail Scale. 2006; 35 (5): 526–9. DOI: 10.1093/ageing/afl041
  5. Hannan E.L., Kilburn H., Jr., Racz M., Shields E., Chassin M.R. Improving the outcomes of coronary artery bypass surgery in New York State. J. Am. Med. Ass. 1999; 271 (10): 761–6. PMID: 8114213
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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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