Minimally Invasive Surgery In Octogenarians: Is Age A Contraindication Or A Prejudice?
Elisa Mikus, Simone Calvi, Carlotta Brega, Alberto Tripodi, Fabio Zucchetta, Alberto Albertini.
Maria Cecilia Hospital, GVM for Care & Research, Cotignola (Ra), Italy.
Background: demographic world changes impose increased age of the patients referred to cardiac surgery. In the mean time, the use of minimally invasive techniques is expanding and becoming more and more daily occurrence for some centers. In our institution, even over 80-year-old patients undergo elective cardiac surgery through mini-access.Methods: Between January 2010 and December 2018, 595 patients (278 male 46.7%; with mean age was 82.5 ± 2.1; range 80-93) underwent minimally invasive cardiac surgery. Minimally invasive approaches included: right mini-thoracotomy (n°=251) for mitral, tricuspid and aortic valve (respectively 4th and 3rd intercostal space), ministernotomy (N°=323) for the aortic valve and/or ascending aorta replacement, left minithoracotomy (n°=21) for bypass or mitral valve repair using neochord. We analysed the preoperative aspects, the perioperative course and 30- day mortality.Results: The most frequent comorbidities were: hypertension 75.8% (451 patients), diabetes 17.5% (104 patients), COPD 11.4% (68 patients), peripheral arteriopathy 8% (48 patients). Mean ejection fraction was 59±9%. Mean Logistic Euroscore and mean Euroscore II were respectively 11.04±6 and 3.1 ± 2.1. Patients were treated for aortic valve disease (n°480), isolated mitral disease (n°72), mitral and aortic disease (n°7) or mitral combined with tricuspid (n°4). The remaining had coronary artery disease (n°16) or ascending aorta dilatation isolated or combined with aortic valve disease (n°12). Other in the lasting 4 patients. Almost all patients were elective (94%), and in 7 (1.2%) patients a previous operation was performed. Median ventilation time and hospital stay were respectively 8 hours and 8 days. Of them, 60.3% received blood transfusions. In-hospital mortality was 3.8 % (23 patients).Conclusions: Minimally invasive surgery can be easy applied in octogenarians, ventilation time and hospital stay are almost comparable to those of youngest patients in our Department
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