Cardiac Surgery in Octogenarians Results in Subjective Gains but No Objective Improvements in Quality of Life or Functional Status after three Months

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Abstracts

Heart, Lung and Circulation 2011;20S:S156–S251

ABSTRACTS

546 Cardiac Surgery in Octogenarians Results in Subjective Gains but No Objective Improvements in Quality of Life or Functional Status after three Months J. Oldroyd 1,∗ , M. Levinson 1,2 , G. Stephenson 1 , J. Reeves 3 , G. Shardey 1 , T. Leeuwrik 1 , G. Hawdon 3 , J. Barrett 3 , J. Lefkovits 1 1 Cabrini

Hospital, Australia Department of Medicine, Australia 3 Intensive Care Unit, Cabrini Hospital, Australia 2 Cabrini-Monash

Objective: To determine health related quality of life (HRQoL), functional status and re-admissions in patients 80 years and older three months after cardiac surgery Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between baseline and three months following cardiac surgery Results: Sixty-three cardiac surgery patients were enrolled. The most frequent surgical procedures were CABG in 27 (43%), CABG + AVR/MVR in 18 (29%), AVR/MVR in 16 (25%). 61 (97%) were elective. Mean (SD) age was 83.2 (2.5) years, 56% were men, and mean (SD) length of hospital stay was 13.4 (5.9) days. Baseline self-reported co-morbidities included hypertension in 39 (62%), osteoarthritis in 27 (43%) and back pain in 21 (33%). After three months follow-up, there was no significant change in HRQoL domain scores (SF-36) or functional status scores compared to baseline. Fifty-one (81%) said that cardiac surgery had been worthwhile. There were two (3%) in-hospital deaths. One (2%) patient died and 16 (25%) were re-admitted to hospital during three month followup. Conclusion: Octogenarians are no worse three months after cardiac surgery than before surgery. Patient’s expectations of cardiac surgery may account for why the majority thought that surgery had been worthwhile despite it making no significant change to HRQoL. Other reasons why HRQoL did not change may be related to short followup time, the high levels of baseline co-morbidities or an individualised construction of HRQoL. Further investigations of octogenarian’s views of what HRQoL means are warranted. doi:10.1016/j.hlc.2011.05.550 547 Cardiac Valve Replacement for Acute Infective Endocarditis in North Queensland K. Burns ∗ The Townsville Hospital, Australia Objective: To examine the prevalence of acute infective endocarditis requiring cardiac valve replacement at The Townsville Hospital from 2008 to 2011 and indications for surgery. Background: Infective endocarditis is an important consideration for patients presenting with fever in both native

and prosthetic heart valves with a significant risk of complications if treatment is delayed. Method: A retrospective analysis of 191 patients revealed nine patients who underwent valve replacement at The Townsville Hospital from 2008 until March 2011 with acute infective endocarditis. The outcome measures were native/prosthetic valve, indication for surgery, timing to surgery, and necessity for pre-surgical coronary angiogram. Results: A total of nine patients underwent valve replacement for active infective endocarditis. The average time to surgery from onset of symptoms was 21.8 days with seven patients presenting to a peripheral centre. The most common complication prior to surgical intervention was septic emboli (55%) followed by heart failure (44%). Native valve endocarditis occurred in 66% of cases and surgery was performed on average 23.6.days after the onset of symptoms. Prosthetic valve endocarditis was found in 33% and surgery was performed on an average of 18.3 days. None of the patients underwent cardiac catheterisation prior to surgery. One patients died following re-do valve surgery. Conclusion: Infective endocarditis requiring surgical management was more common in native valves with time to diagnosis being longer, compared to prosthetic valve endocarditis. Barriers to early surgery included late presentation to hospital and the need for transfer to a tertiary centre. doi:10.1016/j.hlc.2011.05.551 548 Improved Care for Thoracic Aortic Aneurysm—Two Decades Experience S. Andvik ∗ , A. Sherrah, R. Jeremy Royal Prince Alfred Hospital, Australia Thoracic aortic aneurysm is life-threatening, but benefit of intensive long-term follow-up and intervention is not well documented. Methods: Tertiary hospital Aortic Disease Clinic enrolled 732 patients over 20 years; 176 Marfan, 153 isolated or familial aneurysm or dissection (TAAD), 53 bicuspid aortic valves, 23 other (Ehlers-Danlos, LoeysDietz). Another 327 patients had no evidence of aneurysm (controls). Patients had annual echo and clinical review and received medical therapy according to current guidelines. Patient diagnosis, regular use of beta-blockers or angiotensin-blockers and outcomes (death, dissection, surgery) are compared for first and second decades of clinic experience. Results: Although recognition of non-syndromal TAAD has increased, diagnosis for all remains delayed. Use of beta-blockers remains relatively low, but AgII blockers are