Surgical Treatment of Patients With Cardiac Cachexia: Results

Surgical Treatment of Patients With Cardiac Cachexia: ResultsOperative Mortality
Overall operative mortality was 28 percent (7/25 patients), but it differed according to certain risk factors. The factors affecting operative mortality are summarized in Table 4. Preoperative advanced age, female sex, advanced tricuspid regurgitation, preoperative renal failure (serum urea nitrogen >30 mg/ dl), and preoperative hepatic failure (ascites, serum total bilirubin >2.5 mg/dl) did not significantly affect the operative mortality. canadian pharmacy

Patients with preoperative nutritional support had an operative mortality rate of 17 percent (3/18) as compared with a rate of 57 percent (4/7) for patients without nutritional support. This difference was statistically significant (p<0.05). Causes of the three deaths in patients with nutritional support were postoperative bleeding, hepatic failure, and renal failure. In contrast, there were four deaths in patients without nutritional support, and a common cause of these deaths was multiple organ failure triggered by prolonged respiratory failure.
The operative mortality was higher in patients with giant left atrium (39 percent vs 0 percent, p<0.01). Plication of the left atrial wall was performed in 6 of the 19 patients with giant left atrium (Table 5). The procedure of plication played an important role in decreasing cardiac shadow. The postoperative cardiothoracic ratio on chest radiographs was significantly decreased to 74.5 ±5.8 percent from 91.3 ±6.5 percent (p<0.05) However, the operative mortality in patients with plication was still higher than that in patients whose left atrium was left intact (67 percent vs 16 percent, p<0.025). A common cause of the four deaths, as discussed above, was multiple organ failure secondary to prolonged respiratory failure or pneumonia. During the follow-up period, there were 4 late deaths among the 18 operative survivors. Three of these deaths were not related to valve complications, but were due to progressive heart failure. The other death resulted from a thromboembolic event due to a prosthetic valve.

Table 4—Analysis of Factors Associated With Operative Mortality

Factors No. of Patients No. of Deaths %Mortality p Value
Sex NS
Male 12 3 25
Female 13 4 31
Age, yr NS
>60 8 3 37
<60 17 4 24
Preoperative IVH <0.05
No 7 4 57
Yes 18 3 17
TR, >3 NS
No 6 1 17
Yes 19 6 32
Giant LA <0.01
No 7 0 0
Yes 18 7 39
LA plication <0.025
No 19 3 16
Yes 6 4 67
Serum urea nitrogen, mg/dl NS
>30 10 3 30
<30 15 4 27
Serum bilurubin, mg/dl NS
>2.5 7 2 28
<2.5 18 5 28
Ascites NS
No 15 4 27
Yes 10 3 30

Table 5—Clinical Results in Six Patients Who Underwent Left Atrial Plication

Case/Age, yr/Sex Pre-CTR,% Procedures Post-CTR,% Outcome Cause of Death
1/44/F 83 LAP, MVR, TAP 76 Dead Respiratoryfailure
2/58/F 100 LAP, MVR, TAP 67 Alive
3/59/F 93 LAP, MVR, TAP 83 Dead Respiratoryfailure
4/63/F 83 LAP, MVR, TAP AVP 67 Dead LOS
5/57/F 98 LAP, MVR 79 Dead Respiratoryfailure
6/46/F 91 LAP, MVR 75 Survived

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