Abstract
The rapid growth of the elderly population continues to challenge cardiothoracic surgeons to achieve high-quality outcomes that consider a patient’s quality of life (QOL) and functional outcomes. It is imperative that surgeons, cardiologists, geriatricians, and other medical professionals collaborate in multi- and interdisciplinary teams to optimally evaluate frailty and other risk factors and then manage accordingly seniors with symptomatic coronary artery disease (CAD) and aortic stenosis (AS). The current technological advances, clinical investigations, and access to increasingly valuable national registries will allow clinicians to improve the quality of interventions offered to elders with CAD and AS.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Mozaffarian D, Benjamin E, Go AS, et al. Heart disease and stroke statistics—2015 update. Circulation. 2015;131:e29–322.
Bergman H, Ferrucci L, Guralnik J, et al. Frailty: an emerging research and clinical paradigm – issues and controversies. J Gerontol A Biol Sci Med Sci. 2007;62:731–7.
Walston J, McBurnie MA, Newman A, et al. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the cardiovascular health study. Arch Intern Med. 2002;162:2333–41.
Barzilay JI, Blaum C, Moore T, et al. Insulin resistance and inflammation as precursors of frailty: the cardiovascular health study. Arch Intern Med. 2007;167:635–41.
Schaup LA, Pluijm SMF, Deeg DJH, et al. Low testosterone levels and decline in physical performance and muscle strength in older men: findings from two prospective cohort studies. Clin Endocrinol. 2008;68:42–50.
Howell K, Cleveland JC Jr, Meng X. Il-6 production during cardiac surgery correlates with increasing age. J Surg Res. 2016;201(1):76–81.
Afilalo J, Eisenberg MJ, Morin JF, et al. Gait speed as an incremental predictor of mortality and morbidity in elderly patients undergoing cardiac surgery. J Am Coll Cardiol. 2010;56:1668–76.
Sephehri A, Beggs T, Hassan A, et al. The impact of frailty on outcomes after cardiac surgery: a systematic review. J Thorac Cardiovasc Surg. 2014;148:3110–7.
Lin HS, Watts JN, Peel NM, et al. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;15:157.
Kurlansky P. Do octogenarians benefit from coronary artery bypass surgery: a question with a rapidly changing answer? Curr Opin Cardiol. 2012;27:611–9.
Krumhotz HM, Forman DE, Kuntz RE, et al. Coronary revascularization after MI in the very elderly: outcomes and long-term follow up. Ann Intern Med. 1993;119:1084–90.
Kaul TK, Fields BL, Wyatt DA, et al. Angioplasty versus coronary artery bypass in octogenarians. Ann Thorac Surg. 1994;58:1419–26.
Graham MM, Ghali WA, Faris PD, et al. Survival after coronary revascularization in the elderly. Circulation. 2002;105:2378–84.
Fruitman DS, MacDougall CE, Ross DB, et al. Cardiac surgery in octogenarians: can elderly patients benefit? Quality of life after cardiac surgery. Ann Thorac Surg. 1999;68:2129–35.
Leon MB, Smith CR, Mack M, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.
Smith CR, Leon MB, Mack MJ, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.
Adams DH, Popma JJ, Reardon MJ, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370:1790–8.
Mack MJ, Leon MB, Thourani V, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695–705.
Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380:1706–15.
Szeto WY, Svensson LG, Rajeswaran J, et al. Appropriate patient selection or health care rationing? Lessons from surgical aortic valve replacement in the placement of aortic transcatheter valves I trial. J Thorac Cardiovasc Surg. 2015;150:557–68.
Green P, Woglom AE, Genereux P, et al. The impact of frailty status on survival after transcatheter aortic valve replacement in older adults with severe aortic stenosis. J Am Coll Cardiol Intv. 2012;5:974–81.
Kim DH, Afilalo J, Shi S, et al. Evaluation of changes in functional status in the year after aortic valve replacement. JAMA Intern Med. 2019;179(3):383–91.
Afilalo J, Lauck S, Kim DH, et al. Frailty in older adults undergoing aortic valve replacement. The FRAILTY _ AVR Study. J Am Coll Cardiol. 2017;70:689–700.
Kodali S. Early clinical and echocardiographic outcomes with the Sapien 3 transcatheter aortic valve replacement system in inoperable, high-risk, and intermediate-risk aortic stenosis patients. Presented at: American College of Cardiology/i2 Scientific Session; March 15, 2015; San Diego, CA.
Gleason TG, Reardon MJ, Popma JJ, et al. 5 – Year outcomes of self-expanding transcatheter versus surgical aortic valve replacement in high-risk patients. J Am Coll Cardiol. 2018;72:2687–96.
Makkar RR, Thourani VH, Mack MJ, et al. Five-year outcomes of transcatheter or surgical aortic-valve replacement. N Engl J Med. 2020;382:799–809.
Afilalo J, et al. Frailty assessment in the cardiovascular care of older adults. JACC. 2014;63:747–62.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2021 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Cleveland, J.C. (2021). Cardiothoracic Surgery. In: Lee, A.G., Potter, J.F., Harper, G.M. (eds) Geriatrics for Specialists. Springer, Cham. https://doi.org/10.1007/978-3-030-76271-1_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-76271-1_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-76270-4
Online ISBN: 978-3-030-76271-1
eBook Packages: MedicineMedicine (R0)