Cardiothoracic Surgery In The Elderly

Cardiothoracic Surgery in the Elderly: Evidence Based Practice is an important and timely book that reflects the thoughtful work of pioneers in geriatric surgery. It encompasses their knowledge related to geriatric surgery, and their reflections and guidance on the rapidly accumulating knowledge related to improving the health and surgical care of seniors. This book provides a scholarly review of the constantly expanding knowledge base about cardiovascular and thoracic surgery in seniors. The book follows a logical sequence covering general aspects of care, cardiac surgery and thoracic surgery. Chapters are focused on common, devastating and often missed complications of surgical care in the seniors. These include delirium, depression, pressure sores, functional losses, incontinence, volume depletion and asymptomatic or atypical complications -myocardial infarction, post-operative diarrhea, urinary track infections and pneumonia. Each is expertly reviewed. Strategies to help the surgeons and the surgical team anticipate, recognize and effectively prevent or manage such problems are discussed and the evidence basis for such strategies is provided. Cardiothoracic Surgery in the Elderly: Evidence Based Practice is particularly timely and the first to review the substantial body of knowledge that has been developed in recent years related to geriatric cardiothoracic surgical problems. It catalogs well the expanding knowledge basis for achieving successful surgical outcomes in the very old. It provides a most useful resources for cardiovascular thoracic surgeons in training and those already in practice.

This book focuses specifically on the management of cardiovascular disease in elderly patients with particular frailties and in the “oldest old”. It is clearly explained how treatment in these patients differs from that in patients in their seventies who respond well to therapies and do not present frailties or organ failures. Although not young, the latter patients can be treated almost like any other patient, according to established guidelines. In contrast, the frail, compromised elderly and the oldest old require specific measures that target their needs, including with respect to underlying renal conditions. The book considers all those pathologies that have a high prevalence in the general population, explaining advanced treatment concepts and all aspects of assessment. Key clinical points are highlighted, and the text is supplemented with numerous informative figures and tables. The authors are respected experts, for the most part geriatric physicians, and the book is especially addressed to cardiologists, who may lack the described targeted information and treatment tools.

CARLO CONTI You are today confronting sensitive questions on the subject of "Cardiac surgery and heart diseases in old age" and I congratulate you on this. It is a brave and important step to discuss this multifaceted question which demands an answer and an explanation from many perspectives: From a medical perspective, there is the question of the medical feasibility and durability of treatment. From an economic angle we ask ourselves whether we can pay for everything that is medically feasible. From the patient's perspective there is the legitimate de sire and the justified need not to leave anything untried that might serve to sustain or improve the quality of life. The ethical perspective: is what is feasible really desirable? Should everything be done simply because it can be done? Is it ethically acceptable to set an age limit on an opera tion that in all probability will produce an improvement in the quality of life? And if so, where does this limit lie? Below it surgery is "worthwhile" but above it is not? No one in all seriousness and with a clean conscience will want to draw this line randomly or arbitrarily. That ap pears to us - quite rightly - morally unacceptable. The doctors' perspective: they are obliged by the Hippo cratic oath in principle to carry out all the treatments that are indicated and comply with the rules of the art of med ICIne.

A panel of clinicians, researchers, and leaders in the field review and discuss the latest findings on the pathophysiology, diagnosis, and management of cardiovascular disease in the older patient. The authors explain the physiological changes associated with the normal aging process that may lead to the development of disease, to adverse consequences once disease develops, and which alter the risk-benefit equation for medical and other interventions designed to diagnose, assess, and treat cardiovascular disease. The focus is on particularly common syndromes in the elderly, including cardiac failure with normal ejection fraction, isolated systolic hypertension, and atrial fibrillation. Wherever possible, the authors take an evidence-based approach to recommendations and rely heavily on prospective clinical trials.

This book is designed to present a comprehensive and state-of the-art approach to all aspects of geriatric surgery within the broad confines of surgery in geriatrics including general surgery, neurosurgery, thoracic surgery, vascular surgery, cardiac surgery, surgical oncology, hepatobiliary and transplant surgery, plastic, colorectal, orthopedic, gynecologic, and urologic surgery. The text is split into four parts. The first part is organized under general considerations on the geriatric surgical patient and includes current trends in geriatric surgery, and a number of important general issues such as practical approaches to reversal of bleeding/anticoagulation, role of anesthetic concerns in advanced age, frailty index and measurements of physiological reserves, nutritional support in the elderly, quality of life in the elderly, drug use, and family involvement. Part two of the book focuses on surgery specific system-based problems in geriatric surgical patients. The third part addresses many other important aspects of geriatric surgery including palliative and end of life care for the elderly, religious issues and the elderly care surgery, elderly with mental health issues, and nursing care of elderly patients. The fourth and final part describes the need for geriatric surgical care education and the components that are essential for the curriculum of current and future generations of students. Written by experts in the field, Surgical Decision Making in Geriatrics addresses patient selection, pre-operative considerations, technical conduct of the most common operations, and avoiding complications.

Coronary artery bypass surgery in the elderly: Too often or too seldom? It is a testimony to scientific advances that raising a simple inquiry today, such as whether coronary artery bypass surgery is done too often or too seldom in elderlypatients, requiresanexplorationofwhatviewsonemightholdonseveral medical as well as non-medical issues. Unlike earlier years when doctors were clinically free to decide what should be done with a patient, health has become an expensive human right, decisions about which also involve the patient, the epidemiologist, the health policy administrator, politicians, the exchequer, and the philosopher. In its broadest definition health has come to mean the core of well-being and, therefore, the goal ofany socio-economic system. Until only a decade ago, medical opinion regarding how often coronary artery bypass surgery (CABG) was indicated or useful was unclear. Becauseof multi-organ senescence, the elderly were expected to have a higher rate operative morbidity and mortality and, having crossed an advanced life span, might not live very long after the operation. Decision making on medical grounds first depends on knowing if a patient can survive an operation compared to how long they would survive without it, i. e.

This book provides an in depth review of the current practice in treating elderly patients with coronary artery disease (CAD) as well as an update of the existing literature. It is intended to reflect the current science of elderly patients with stable angina, acute coronary syndromes and those patients who are forwarded for CAGB procedures. Evidence in the elderly patient group is often limited and/or non-existent therefore the main challenge, even for further research, will be to define the role of geriatric preconditions and its impact on outcome. A second topic will be to clarify how, if ever, existing cardiological outcome values like mortality can be applied to elderly patients or if other values like improvement of functional status or quality of life are more suitable parameters to measure interventional success in elderly patients. The role of pharmacotherapy in advanced age has to be discussed. These topics will be embedded in epidemiological, pathophysiological and ethical aspects of interventional treatment of CAD in older age.

This book aims to clarify the potential association between frailty and cardiovascular disease in older people. Covering the biological as well as the clinical point of view, it allows researchers and clinicians to discover the significance of this topic. The contributions cover the most important aspects in the potential relationship between frailty and cardiovascular disease. In particular, authoritative authors in this field have clarified the definition and the epidemiology of frailty and cardiovascular disease in older people. A large part of the volume is dedicated to the biological mechanisms of frailty and cardiovascular disease, trying to find those in common between these two conditions. Since this book is dedicated to both researchers and clinicians, we have proposed some chapters to the importance of comprehensive geriatric assessment in the evaluation and treatment of cardiovascular diseases and frailty. In this regard, the importance of geriatric evaluation in cardiac surgery for older people is well covered. Finally, the importance of cardiac rehabilitation and physical exercise is summarized, being, actually, the most important treatments for both frailty and cardiovascular disease. Written by many well-known and widely published experts in their respective fields, this book will appeal to a wide readership such as researchers in the field and clinicians, especially suited in geriatric medicine and cardiology who, every day, face frail older patients.