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Early Outcomes with Repeat Sternotomy in Octogenarians undergoing Surgical Aortic Valve Replacement (AVR)
e103
Abstracts
Surgical Management of Malignant Pleural Mesothelioma – Can We Do Better? Prakash Balakrishnan *, Indra Nordstrand, Barry Mahon, Sean Galvin, John Riordan Wellington Regional Hospital, Wellington, New Zealand Purpose: Among all thoracic malignancies, the management of malignant pleural mesothelioma is probably the most controversial, in view of its surgical treatment. Surgical entity and approaches around this aggressive and rare disease process involves either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D.) Poor survival rates with no standardised therapy or guidelines regarding its treatment has prompted our study to look further into its role of surgery and quantitative analysis of its postoperative outcomes. Methodology: Electronic searches (systematic reviews) among the 6 online databases were conducted to assess the efficacies, complication rates and long-term postoperative outcomes of EPP and P/D according to the IASLC protocols. Surgical outcomes were compared and quantitatively analysed. Results: Approximately 40 studies regarding both surgical treatment - EPP and P/D were cross-examined and reviewed for efficacy, complication rates, median overall survival rates, perioperative mortality rates and long-term survival rates. On the whole, the overall survival rates favoured the extended P/D group vs the EPP group, which is less then 3 years at its best. Conclusion: Both surgical options have illustrated marked improvements in local control as an adjunct to delivery of chemoradiation therapy and significant survival advantages. High morbidity-related rates and risks looms among these options – hence strategic and appropriate patient selection is vital for achieving acceptable long-term survival rates. http://dx.doi.org/10.1016/j.hlc.2015.12.046 Early Outcomes with Repeat Sternotomy in Octogenarians undergoing Surgical Aortic Valve Replacement (AVR) Laura Fong *, Nikki Stamp, Yishay Orr, Robert Costa Department of Cardiothoracic Surgery, Westmead Hospital, Syndey, NSW, Australia Objective: There is limited data on the outcomes of repeat sternotomy for surgical AVR as an isolated or combined procedure in octogenarian patients, with some series reporting an operative mortality of up to 20%. We sought to determine the risk of repeat sternotomy versus primary sternotomy in the current era for octogenarian patients undergoing surgical AVR at our institution. Methods: We conducted a retrospective review of 86 octogenarian patients who underwent AVR at Westmead Hospital between April 2010 and February 2015. Results: Mean patient age was 83 2.7 years and 54 patients (63%) were male. Primary sternotomy was performed in 73 patients (85.9%), while repeat sternotomy
was performed in 13 patients (14.1%). Combined procedures were performed in 58% of patients who had primary sternotomy compared to 39% of patients who had repeat sternotomy. Cardiopulmonary bypass times were similar with primary (123 45 minutes) and repeat sternotomy (99 47; p = 0.09). Mean ICU length of stay was 8 7.2 days and hospital length of stay was 22 22.8 days for primary sternotomy, compared to 7 3.6 days, and 19 13.1 days respectively for repeat sternotomy. Conclusion: Repeat sternotomy and surgical AVR can be performed safely with acceptable peri-operative risk in octogenarian patients with previous coronary artery bypass grafts. Although there is a trend to longer cardiopulmonary bypass times with primary sternotomy this likely relates to the higher incidence of combined procedures in this group. Importantly, repeat sternotomy was not predictive of operative mortality. http://dx.doi.org/10.1016/j.hlc.2015.12.047 Early Outcomes of Surgical Aortic Valve Replacement in Octogenarians Laura Fong *, Nikki Stamp, Yishay Orr, Robert Costa Department of Cardiothoracic Surgery, Westmead Hospital, Syndey, NSW, Australia Objective: Recently transcatheter aortic valve implantation has increasingly been advocated for elderly high-risk patients with symptomatic severe aortic stenosis to limit procedural risk. This has renewed interest in contemporary outcomes for surgical AVR in these patients. To better delineate perioperative risk for octogenarians undergoing surgical AVR in the current era, we reviewed recent outcomes for these patients in our institution. Methods: We conducted a retrospective analysis of 100 patients aged 80 years and older who underwent surgical AVR at Westmead Hospital between October 2008 and February 2015. Major outcome measures included 30-day mortality, intensive care unit (ICU) and hospital length of stay, postoperative infection, acute renal failure, cerebrovascular events, new arrhythmia, and reoperation. Results: Mean age was 83 2.6 years, 60 patients were male and 8% of patients had severely impaired LV function. Mean cardiopulmonary bypass time was 120 45.8 minutes and mean cross-clamp time was 90 36.4 minutes. All patients underwent bioprosthetic aortic valve replacement with a mean valve size of 23 mm. An intra-aortic balloon pump was used to facilitate weaning from cardiopulmonary bypass in 5 cases. Mean ventilation time was 44 83.4 hours, mean ICU length of stay was 8 6.8 days and mean length of hospital stay was 21 21.5 days. The 30-day mortality rate was 10%. Three patients required reoperation for insertion of defibrillator or permanent pacemaker. Conclusion: Surgical AVR can be performed with acceptable risk in octogenarians with minimal associated postoperative complications. Significant resource utilisation is necessary to ensure successful perioperative outcomes and early survival. http://dx.doi.org/10.1016/j.hlc.2015.12.048
Abstracts
Surgical Management of Malignant Pleural Mesothelioma – Can We Do Better? Prakash Balakrishnan *, Indra Nordstrand, Barry Mahon, Sean Galvin, John Riordan Wellington Regional Hospital, Wellington, New Zealand Purpose: Among all thoracic malignancies, the management of malignant pleural mesothelioma is probably the most controversial, in view of its surgical treatment. Surgical entity and approaches around this aggressive and rare disease process involves either extrapleural pneumonectomy (EPP) or pleurectomy/decortication (P/D.) Poor survival rates with no standardised therapy or guidelines regarding its treatment has prompted our study to look further into its role of surgery and quantitative analysis of its postoperative outcomes. Methodology: Electronic searches (systematic reviews) among the 6 online databases were conducted to assess the efficacies, complication rates and long-term postoperative outcomes of EPP and P/D according to the IASLC protocols. Surgical outcomes were compared and quantitatively analysed. Results: Approximately 40 studies regarding both surgical treatment - EPP and P/D were cross-examined and reviewed for efficacy, complication rates, median overall survival rates, perioperative mortality rates and long-term survival rates. On the whole, the overall survival rates favoured the extended P/D group vs the EPP group, which is less then 3 years at its best. Conclusion: Both surgical options have illustrated marked improvements in local control as an adjunct to delivery of chemoradiation therapy and significant survival advantages. High morbidity-related rates and risks looms among these options – hence strategic and appropriate patient selection is vital for achieving acceptable long-term survival rates. http://dx.doi.org/10.1016/j.hlc.2015.12.046 Early Outcomes with Repeat Sternotomy in Octogenarians undergoing Surgical Aortic Valve Replacement (AVR) Laura Fong *, Nikki Stamp, Yishay Orr, Robert Costa Department of Cardiothoracic Surgery, Westmead Hospital, Syndey, NSW, Australia Objective: There is limited data on the outcomes of repeat sternotomy for surgical AVR as an isolated or combined procedure in octogenarian patients, with some series reporting an operative mortality of up to 20%. We sought to determine the risk of repeat sternotomy versus primary sternotomy in the current era for octogenarian patients undergoing surgical AVR at our institution. Methods: We conducted a retrospective review of 86 octogenarian patients who underwent AVR at Westmead Hospital between April 2010 and February 2015. Results: Mean patient age was 83 2.7 years and 54 patients (63%) were male. Primary sternotomy was performed in 73 patients (85.9%), while repeat sternotomy
was performed in 13 patients (14.1%). Combined procedures were performed in 58% of patients who had primary sternotomy compared to 39% of patients who had repeat sternotomy. Cardiopulmonary bypass times were similar with primary (123 45 minutes) and repeat sternotomy (99 47; p = 0.09). Mean ICU length of stay was 8 7.2 days and hospital length of stay was 22 22.8 days for primary sternotomy, compared to 7 3.6 days, and 19 13.1 days respectively for repeat sternotomy. Conclusion: Repeat sternotomy and surgical AVR can be performed safely with acceptable peri-operative risk in octogenarian patients with previous coronary artery bypass grafts. Although there is a trend to longer cardiopulmonary bypass times with primary sternotomy this likely relates to the higher incidence of combined procedures in this group. Importantly, repeat sternotomy was not predictive of operative mortality. http://dx.doi.org/10.1016/j.hlc.2015.12.047 Early Outcomes of Surgical Aortic Valve Replacement in Octogenarians Laura Fong *, Nikki Stamp, Yishay Orr, Robert Costa Department of Cardiothoracic Surgery, Westmead Hospital, Syndey, NSW, Australia Objective: Recently transcatheter aortic valve implantation has increasingly been advocated for elderly high-risk patients with symptomatic severe aortic stenosis to limit procedural risk. This has renewed interest in contemporary outcomes for surgical AVR in these patients. To better delineate perioperative risk for octogenarians undergoing surgical AVR in the current era, we reviewed recent outcomes for these patients in our institution. Methods: We conducted a retrospective analysis of 100 patients aged 80 years and older who underwent surgical AVR at Westmead Hospital between October 2008 and February 2015. Major outcome measures included 30-day mortality, intensive care unit (ICU) and hospital length of stay, postoperative infection, acute renal failure, cerebrovascular events, new arrhythmia, and reoperation. Results: Mean age was 83 2.6 years, 60 patients were male and 8% of patients had severely impaired LV function. Mean cardiopulmonary bypass time was 120 45.8 minutes and mean cross-clamp time was 90 36.4 minutes. All patients underwent bioprosthetic aortic valve replacement with a mean valve size of 23 mm. An intra-aortic balloon pump was used to facilitate weaning from cardiopulmonary bypass in 5 cases. Mean ventilation time was 44 83.4 hours, mean ICU length of stay was 8 6.8 days and mean length of hospital stay was 21 21.5 days. The 30-day mortality rate was 10%. Three patients required reoperation for insertion of defibrillator or permanent pacemaker. Conclusion: Surgical AVR can be performed with acceptable risk in octogenarians with minimal associated postoperative complications. Significant resource utilisation is necessary to ensure successful perioperative outcomes and early survival. http://dx.doi.org/10.1016/j.hlc.2015.12.048