Revista portuguesa de cirurgia cardio-toracica e vascular : orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular · 2009
[Results of carotid endarterectomy in octogenarians: a 10-years personal experience].
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Bonamigo Telmo, Lucas Márcio, Pivatto Junior Fernando
Аннотация
PURPOSE: Some investigators consider octogenarians as high risk patients for carotid endarterectomy (CEA). The objective of our study was determine the results of CEA in the octogenarians patients.
PATIENTS AND METHODS: Between January 1998 and May 2008, 755 CEAs were performed by the first author. Of these, 73 (9.7%) were performed in 69 octogenarians (40 men, 29 women) with a median age of 83 years (range, 80 to 90 years ). Before the procedures, 46 patients (63%) were asymptomatic and 27 (37%) had a severe (>70%) asymptomatic stenosis. Hypertension (68.1%), tobacco history (47.8%) and ischemic cardiopathy (39.1%) were the most prevalent comorbidities. Surgical data and perioperative results such as ocurrence of stroke, transitory ischemic atacks, need for re-operation and death as a long term survival estimate by Kaplan Meier method were analysed.
RESULTS: Of all 73 operations, there was two early (<30 days( postoperative deaths (2.7%) due to pulmonary sepsis in a patient submitted to myocardial revascularization simultaneously and due to a fatal stroke in another patient. There was one non-fatal stroke (1.4%) due to early (eighth post-operative day) carotid thrombosis; and one non-fatal myocardial infarction (1.4%). Another four patients (5.5%) were submitted to early reoperation due to neck hematoma. Of patients that have been discharged (n=67), late information was available in 55 patients (82.1%) and the Kaplan-Meier estimated 5-year survival rate was 60.6%.
CONCLUSIONS: We conclude that CEA may be performed in selected octogenarians patients to treat carotid occlusive disease with good results. Therefore, age alone should not be considered as a prohibitive risk factor for patients candidates for CEA.
PATIENTS AND METHODS: Between January 1998 and May 2008, 755 CEAs were performed by the first author. Of these, 73 (9.7%) were performed in 69 octogenarians (40 men, 29 women) with a median age of 83 years (range, 80 to 90 years ). Before the procedures, 46 patients (63%) were asymptomatic and 27 (37%) had a severe (>70%) asymptomatic stenosis. Hypertension (68.1%), tobacco history (47.8%) and ischemic cardiopathy (39.1%) were the most prevalent comorbidities. Surgical data and perioperative results such as ocurrence of stroke, transitory ischemic atacks, need for re-operation and death as a long term survival estimate by Kaplan Meier method were analysed.
RESULTS: Of all 73 operations, there was two early (<30 days( postoperative deaths (2.7%) due to pulmonary sepsis in a patient submitted to myocardial revascularization simultaneously and due to a fatal stroke in another patient. There was one non-fatal stroke (1.4%) due to early (eighth post-operative day) carotid thrombosis; and one non-fatal myocardial infarction (1.4%). Another four patients (5.5%) were submitted to early reoperation due to neck hematoma. Of patients that have been discharged (n=67), late information was available in 55 patients (82.1%) and the Kaplan-Meier estimated 5-year survival rate was 60.6%.
CONCLUSIONS: We conclude that CEA may be performed in selected octogenarians patients to treat carotid occlusive disease with good results. Therefore, age alone should not be considered as a prohibitive risk factor for patients candidates for CEA.