Outcome after valve surgery in octogenarians and efficacy of early mobilization with early cardiac rehabilitation

• Published in: General thoracic and cardiovascular surgery Vol. 58; no. 12; pp. 606 - 611
• Main Authors: Nakamura, Kunihide, Nakamura, Eisaku, Niina, Katsuhiko, Kojima, Kazushi
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.12.2010; Springer Nature B.V
• Subjects: Age Factors; Aged; Aged, 80 and over; Blood Vessel Prosthesis Implantation - adverse effects; Cardiac Surgery; Cardiology; Chi-Square Distribution; Coronary Artery Bypass - adverse effects; Delirium; Early Ambulation; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Heart Valve Prosthesis Implantation - rehabilitation; Hospital Mortality; Humans; Japan; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Postoperative Complications - etiology; Rehabilitation; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Surgery; Surgical Oncology; Survival Analysis; Survival Rate; Thoracic Surgery; Time Factors; Treatment Outcome; Japan; Early mobilization; EuroScore; Octogenarians; Valve surgery; Cardiac rehabilitation
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-010-0665-0

Purpose This study aimed to compare postoperative complications and the surgical outcome in patients aged <80 years versus octogenarian patients. Another aim was to evaluate the safety and efficacy of early mobilization with early cardiac rehabilitation in octogenarians. Methods A retrospective analysis was performed in 138 consecutive patients (group Y comprised 118 patients <80 years, and group O comprised 20 octogenarians) who had undergone valve surgery at the authors’ institution between July 2007 and December 2009. Furthermore, the efficacy of early mobilization with early cardiac rehabilitation and long-term results were analyzed in 40 consecutive octogenarian patients undergoing valve surgery from 2000. The late survival follow-up was 100% complete. Results Redo cardiac operations were more frequent (O group 15.0% vs. Y group 3.4%, P = 0.011), and the preoperative EuroSCORE was significantly higher in group O than in group Y (group O 16.4 ± 18.3 vs. group Y 7.5 ± 9.1, P = 0.001). The incidence of delirium/confusion and worsening of renal function after surgery was higher in group O. The hospital mortality was 1.7% in group Y and no hospital death in group O ( P > 0.99). Early mobilization with early cardiac rehabilitation significantly reduced the incidence of postoperative delirium/confusion and increased the number of patients who could return directly home. The actuarial 5-year survival rate was 77.7% for octogenarians. Conclusion Although there were more high-risk patients among the octogenarians, valve surgery was a safe, lowrisk procedure with excellent long-term results. Early mobilization with early cardiac rehabilitation was significantly effective and safe for postoperative recovery in octogenarians after cardiac valve surgery.