The Analysis of Quality of Life With Karnofsky Scoring System in Octogenerians After Open Heart Surgery
Year 2009,
Volume: 1 Issue: 2, 5 - 12, 01.08.2009
Mahmut Akyıldız
Tamer Aksoy
Esra Ertürk
Yılmaz Zorman
Benay Erden
Lütfi Çağatay Onar
Mustafa Serdar Yılmazer
Harun Arbatlı
Abstract
Objective: Number of elderly patients who underwent open heart surgery increasesdaybyday. Also therearemany articles mentioning aboutthesafety and effi ciency of open heart surgery in elderly patients. That retrospective study aims to execute the quality of life by using “Karnofsky Performance Status Scale” for octogenarian patients underwent open heart surgery. We analyzed theperformancestatusof 32 patients todeterminetheirKarnofsky scorewhichcanshowtheirexactperformancestatuswithalgebraicresults. Methods: There were 32 octogenarian patients mean age 86,78 ±2.6 of totally424patients whounderwentopen heartsurgerybetweenthedatesof September 2005 and February 2008. Hospital records were analyzed retrospectively and compared with the current results. Results: There were 19 male and 13 female patients. Three of our patients underwentaortic valvereplacementoperation, onepatientwasunderwent coronary artery bypass grafting surgery combined with aortic valve replacement and 28 of all patients were underwent isolated coronary artery bypass grafting surgery. Conclusions: For octogenarian patients open heart surgery requires a little longer staysin hospital comparingwithyoungergroups. Butopen heart surgery can be performed with acceptable morbidity and mortality rates. For these patients early evaluation and admission to surgery improves the outcomes whereasimportantmodifi cations of cardiopulmonary bypass techniques are also eff ective.
References
- 1. 1.Ivanov RN, Weisel RD, David TE, Naylor D: Fifteen-year trends in risk severity and operative mortality in elderly patients undergoing coronary artery bypass graft surgery.Circulation 1998;97:673-680.
- 2. Katz NM, Hannan RL, Hopkins RA, Wallace RB: Cardiac operations in patients aged 70 years and over. Ann Thorac Surg 1995;60:96-101.
- 3. Tsai TP, Chaux A, Matloff JM: Ten year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994;58:441-451.
- 4. Yorgancıoğlu C, Tezcaner T, Tokmakoğlu H, ve ark.: İleri yaş grubunda koroner bypass deneyimi. GKDC Dergisi 1999;7:30-35.
- 5. Katz NM, Chase GA: Risks of cardiac operations for elderly patients: reduction of the age factor. Ann Thorac Surg 1997;63:1309-1314.
- 6. Holman WL: Long term results of coronary artery bypass grafting. Current Opinion in Cardiology 1992; 7:990-996.
- 7. Estafanous FG, Higgins T, Loop F: A severity score for preoperative risk factors as related to morbidity and mortality in patients with coronary artery disease undergoing myocardial revascularization surgery. Current Opinion in Cardiology 1992;7:950-958.
- 8. Rosenfeld FL, Wong J: Current expectations for survival and complications in coronary artery bypass grafting. Current Opinion in Cardiology 1993;8:910- 918.
- 9. Wei JY. Heart disease in the elderly. Cardiovasc. Med 1984;9:971-982.
- 10. Horvath KA, DiSesa VJ, Peigh PS, Couper GS, Collins JJ, Cohn LH. Favorable results coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg 1990;99:92-96.
- 11. Tsai TP,Nessim S,Kass RM,Chaux A,Gray RJ,Khan SS,Blanche C,Utley C,Matloff JM.Morbidity and mortality after coronary artery bypass in octogenerians. Ann Thorac Surg 1991;51:983-986.
- 12. Aranki SF,Rizzo RJ,Couper GS,Adams DA,Collins JJ,Gildea JS,Kinchla NM,Cohn LH.Aortic valv replacement in the elderly.Eff ect of gender and coronary artery disease on operative mortality Circulation 1993;88:17-23.
- 13. Cane ME,Chen C,Bailey BM,Fernandez J,Laub GW,Anderson WA.McGrath LB.CABG in octogenerians:early and late events and actuarial survival in comparison with a matched population.Ann Thorac Surg 1995;60:1033-1037.
- 14. Elayda MA,Hail RJ,Reul RM,Alanzo DM,Gilette N,Reul GJ,Cooley DA.Aortic valv replacement in patients 80 years and older.Operative risks and long term results. Circulation 1993;88:11-16.
- 15. Fernandez J,Chen C,Anolik G,Brdlik OB,Luub GW,Anderson WA,McGrath LB.Perioperative risk factors aff ecting hospital stay and hospital costs in open heart surgery for patients 65 years old. Cardio-thoracic Surg 1997;11:1133-1140.
- 16. Freeman WK,Schaff HV,Brı PCO,Orszulak TA,Naessens J M, Tajik AJ:Cardiac surgery in the octogenerian:Perioperative outcome and clinical follow-up.J Am Coll Cardiol 1991;18:29-35.
- 17. Ko W,Gold JP,Lazzaro R,Zelano JA,Lang S,Isom OW,Krieger KH Survival analysis of octogenerian patients with coronary artery disease managed by elective coronary artery by pass surgery versus conventional medical treatment. Circulation 1992;86:191-197.
- 18. Tsai TP,Nessim S,Kass RM,Chaux A,Gray RJ,Khan SS,Blanche C,Utley C,Matloff JM. Morbidity and mortality after coronary artery bypass in octogenerians. Ann Thorac Surg 1991;51:983-986.
- 19. Kumar P,Zehr KJ,Chang A,Cameron ED,Baumgartner WA. Quality of life in octogenarians after open heart surgery Chest 1995; 108:919-926.
- 20. Karnofsky DA, Burchenal JH“The Clinical Evaluation of Chemotherapeutic Agents in Cancer.” In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ. Press..1949. Page 196.
- 21. Buckberg GD, Beyersdorf F, Kato NS. Technical considerations and logic of antegrade and retrograde cardioplegic delivery. Semin Thorac Cardiovasc Surg 1993;5: 125-33.
- 22. Kirch M, Guesnier L, LeBesnerais P et al. Cardiac operations in octogenarians: Perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998;66: 60-67.
- 23. Unger F. The changing image in cardiac surgery. J Cardiovasc Surg (Torino) 1994; 35(suppl 1): 1-5
- 24. .Mullany CJ, Mock MB, Brooks MM, et al. Eff ect of gae in Bypass Angioplasty Revascularization İnvestigation (BARI) randomized trial. Ann Thorac Surg 1999; 67:396-403.
- 25. Salerno DM, Dias VC, Kleiger RE, et al. Eff icacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial fl utter. The Diltiazem- Atrial Fibrillation / Flutter Study Group. Am J Cardiol 1989; 63: 1046-1051.
- 26. Malhotra R, Mishra M, Kler TS, Kohli VM, Mehta Y, Trehan N. Cardioprotective eff ects of diltiazem infusion in the perioperative period. Eur J Cardiothorac Surg 1997;12: 420-427.
- 27. Craver JM, Puskas SD,Weintraub W et al. 601 octogenearians undergoing cardiac surgery; Outcome and comparison with younger age groups. Ann Thorac Surg 1999; 67 :1104-1010.
- 28. Weintraub W, Clements SD, Ware J et al. Coronarya artery surgery in octogenarirans. Am J Cardiol 1991;68:1530-4.
- 29. Murkin JM. Etiology and incidence of brain dysfunction after cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13 (Suppl 1) : 7-36.
- 30. Culliford AT, Colvin SB, Rohrer K, Baumann FG, Spencer FC. The atherosclerotic ascending aorta and transverse arch: A new Technique to prevent cerebral injury during bypass. Ann thorac Surg 1986; 41: 27- 35.
- 31. Tsai T-P , Chaux A, Matloff JM, et al. Ten year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994; 58: 445-451.
80'li Yaşlarda Açık Kalp Cerrahisi Sonrası Yaşam Kalitesinin “Karnofsky Skoru” ile Analizi
Year 2009,
Volume: 1 Issue: 2, 5 - 12, 01.08.2009
Mahmut Akyıldız
Tamer Aksoy
Esra Ertürk
Yılmaz Zorman
Benay Erden
Lütfi Çağatay Onar
Mustafa Serdar Yılmazer
Harun Arbatlı
Abstract
Amaç: Günümüzde ileri yaşta açık kalp cerrahisi gereken hastaların sayısı giderek artmaktadır. Birçok bildiri kalp cerrahisinin yaşlılarda güvenli ve kısa dönem sonuçlarının yararlı olduğunu göstermektedir. Bu retrospektif çalışmada; kliniğimizde açık kalp ameliyatı yapılan 80 yaş ve üzeri hastaların erken ve geç dönem sonuçları incelenmiş ve hastaların ameliyat sonrası yaşam kaliteleri; bir performans ve yaşam kalitesi değerlendirme yöntemi olan Karnofsky skorlama yöntemi kullanılarak analiz edildi. Yöntem: Kliniğimizde Eylül 2005 ile Şubat 2008 yılları arasında açık kalp ameliyatı yapılan 424 hastadan 32'sinin 80 yaş ve üzerinde ortalama 86,78±2.6 olduğu belirlendi. Elde edilen kayıtlar retrospektif olarak değerlendirildi. Bulgular: Hastalarımızın 19'u erkek , 13'ü ise kadındı. Hastalarımızdan 3'üne izole aortik valv replasmanı, 1 hastaya kombine koroner bypass + aortikkapakreplasmanı, 28hastayaiseizolekoronerbypasoperasyonuyapıldı. Sonuç: 80 yaş ve üzerindeki hasta grubunda açık kalp cerrahisi hastanede kalış süresinin uzaması ve normalden biraz daha yüksek ancak kabul edilebilir bir mortalite ve morbidite oranları göz önüne alınarak uygulanabilir. Bu hastaların erken safhada ameliyata yönlendirilmesi ve kardiyopulmoner bypass KPB tekniğinde yapılan hastaya özgü modifikasyonlar sonuçların iyileşmesinde etkili olmaktadır.
References
- 1. 1.Ivanov RN, Weisel RD, David TE, Naylor D: Fifteen-year trends in risk severity and operative mortality in elderly patients undergoing coronary artery bypass graft surgery.Circulation 1998;97:673-680.
- 2. Katz NM, Hannan RL, Hopkins RA, Wallace RB: Cardiac operations in patients aged 70 years and over. Ann Thorac Surg 1995;60:96-101.
- 3. Tsai TP, Chaux A, Matloff JM: Ten year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994;58:441-451.
- 4. Yorgancıoğlu C, Tezcaner T, Tokmakoğlu H, ve ark.: İleri yaş grubunda koroner bypass deneyimi. GKDC Dergisi 1999;7:30-35.
- 5. Katz NM, Chase GA: Risks of cardiac operations for elderly patients: reduction of the age factor. Ann Thorac Surg 1997;63:1309-1314.
- 6. Holman WL: Long term results of coronary artery bypass grafting. Current Opinion in Cardiology 1992; 7:990-996.
- 7. Estafanous FG, Higgins T, Loop F: A severity score for preoperative risk factors as related to morbidity and mortality in patients with coronary artery disease undergoing myocardial revascularization surgery. Current Opinion in Cardiology 1992;7:950-958.
- 8. Rosenfeld FL, Wong J: Current expectations for survival and complications in coronary artery bypass grafting. Current Opinion in Cardiology 1993;8:910- 918.
- 9. Wei JY. Heart disease in the elderly. Cardiovasc. Med 1984;9:971-982.
- 10. Horvath KA, DiSesa VJ, Peigh PS, Couper GS, Collins JJ, Cohn LH. Favorable results coronary artery bypass grafting in patients older than 75 years. J Thorac Cardiovasc Surg 1990;99:92-96.
- 11. Tsai TP,Nessim S,Kass RM,Chaux A,Gray RJ,Khan SS,Blanche C,Utley C,Matloff JM.Morbidity and mortality after coronary artery bypass in octogenerians. Ann Thorac Surg 1991;51:983-986.
- 12. Aranki SF,Rizzo RJ,Couper GS,Adams DA,Collins JJ,Gildea JS,Kinchla NM,Cohn LH.Aortic valv replacement in the elderly.Eff ect of gender and coronary artery disease on operative mortality Circulation 1993;88:17-23.
- 13. Cane ME,Chen C,Bailey BM,Fernandez J,Laub GW,Anderson WA.McGrath LB.CABG in octogenerians:early and late events and actuarial survival in comparison with a matched population.Ann Thorac Surg 1995;60:1033-1037.
- 14. Elayda MA,Hail RJ,Reul RM,Alanzo DM,Gilette N,Reul GJ,Cooley DA.Aortic valv replacement in patients 80 years and older.Operative risks and long term results. Circulation 1993;88:11-16.
- 15. Fernandez J,Chen C,Anolik G,Brdlik OB,Luub GW,Anderson WA,McGrath LB.Perioperative risk factors aff ecting hospital stay and hospital costs in open heart surgery for patients 65 years old. Cardio-thoracic Surg 1997;11:1133-1140.
- 16. Freeman WK,Schaff HV,Brı PCO,Orszulak TA,Naessens J M, Tajik AJ:Cardiac surgery in the octogenerian:Perioperative outcome and clinical follow-up.J Am Coll Cardiol 1991;18:29-35.
- 17. Ko W,Gold JP,Lazzaro R,Zelano JA,Lang S,Isom OW,Krieger KH Survival analysis of octogenerian patients with coronary artery disease managed by elective coronary artery by pass surgery versus conventional medical treatment. Circulation 1992;86:191-197.
- 18. Tsai TP,Nessim S,Kass RM,Chaux A,Gray RJ,Khan SS,Blanche C,Utley C,Matloff JM. Morbidity and mortality after coronary artery bypass in octogenerians. Ann Thorac Surg 1991;51:983-986.
- 19. Kumar P,Zehr KJ,Chang A,Cameron ED,Baumgartner WA. Quality of life in octogenarians after open heart surgery Chest 1995; 108:919-926.
- 20. Karnofsky DA, Burchenal JH“The Clinical Evaluation of Chemotherapeutic Agents in Cancer.” In: MacLeod CM (Ed), Evaluation of Chemotherapeutic Agents. Columbia Univ. Press..1949. Page 196.
- 21. Buckberg GD, Beyersdorf F, Kato NS. Technical considerations and logic of antegrade and retrograde cardioplegic delivery. Semin Thorac Cardiovasc Surg 1993;5: 125-33.
- 22. Kirch M, Guesnier L, LeBesnerais P et al. Cardiac operations in octogenarians: Perioperative risk factors for death and impaired autonomy. Ann Thorac Surg 1998;66: 60-67.
- 23. Unger F. The changing image in cardiac surgery. J Cardiovasc Surg (Torino) 1994; 35(suppl 1): 1-5
- 24. .Mullany CJ, Mock MB, Brooks MM, et al. Eff ect of gae in Bypass Angioplasty Revascularization İnvestigation (BARI) randomized trial. Ann Thorac Surg 1999; 67:396-403.
- 25. Salerno DM, Dias VC, Kleiger RE, et al. Eff icacy and safety of intravenous diltiazem for treatment of atrial fibrillation and atrial fl utter. The Diltiazem- Atrial Fibrillation / Flutter Study Group. Am J Cardiol 1989; 63: 1046-1051.
- 26. Malhotra R, Mishra M, Kler TS, Kohli VM, Mehta Y, Trehan N. Cardioprotective eff ects of diltiazem infusion in the perioperative period. Eur J Cardiothorac Surg 1997;12: 420-427.
- 27. Craver JM, Puskas SD,Weintraub W et al. 601 octogenearians undergoing cardiac surgery; Outcome and comparison with younger age groups. Ann Thorac Surg 1999; 67 :1104-1010.
- 28. Weintraub W, Clements SD, Ware J et al. Coronarya artery surgery in octogenarirans. Am J Cardiol 1991;68:1530-4.
- 29. Murkin JM. Etiology and incidence of brain dysfunction after cardiac surgery. J Cardiothorac Vasc Anesth. 1999;13 (Suppl 1) : 7-36.
- 30. Culliford AT, Colvin SB, Rohrer K, Baumann FG, Spencer FC. The atherosclerotic ascending aorta and transverse arch: A new Technique to prevent cerebral injury during bypass. Ann thorac Surg 1986; 41: 27- 35.
- 31. Tsai T-P , Chaux A, Matloff JM, et al. Ten year experience of cardiac surgery in patients aged 80 years and over. Ann Thorac Surg 1994; 58: 445-451.