Coronary Bypass Surgery In The Elderly

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.

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 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.

Reviews the best therapies and surgical techniques available to provide quality care for the elderly cardiac patient and of those areas that require further research. The authors detail preventive therapies and the cardiovascular syndromes that disproportionately afflict the older individual, including arrhythmias (particularly atrial fibrillation), syncope, heart failure (particularly diastolic heart failure), and ischemic heart disease. They also delineate the surgical management of the heart patient with discussions of postoperative management and its complications and of specific surgical procedures such as coronary artery bypass grafting, valve surgery, pacemaker and defibibrillators, and surgical management of heart failure.

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.

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.

The aim of this textbook is to give guidance in prevention, lifestyle counselling and rehabilitation for cardiologists, other physicians and many different categories of health professionals in cardiac rehabilitation teams.

The technical evolution of cardiac surgery in the last decades has been rewarded with long-term survival with few complications. A matching improvement in the quality of this survival as subjectively felt by the patient has now become the most important to assess the justification of surgery.