Aortic valve surgery in octogenarians: Risk factors and long-term impact

Predictors of haematocrit in lumbar fusion for lumbar disc herniation: a surgical assessment

BACKGROUND

Low haematocrit (Hct) is associated with a higher rate of post-operative complications, increased mortality, and additional medical costs following cardiac surgery. Predictors of post-operative Hct in lumbar fusion are unclear and may be beneficial in avoiding adverse surgical outcomes.

METHODS

A total of 704 lumbar disc herniation patients (385 males, 319 females) who underwent primary lumbar fusion surgery were reviewed in this retrospective study.

RESULTS

In the 687 patients who met the selection criteria, the pre-operative Hct was 41.23 ± 4.57%, the post-operative Hct was 32.61 ± 4.52%, the peri-operative Hct decline was 8.62 ± 4.07%, the estimated intra-operative blood loss was 586.76 ± 346.62 mL, and the post-operative drainage was 489.33 ± 274.32 mL. Pre-operative Hct, estimated blood volume, estimated intra-operative blood loss, post-operative drainage, allogeneic blood transfusion, and age showed significant correlations with post-operative Hct, and all factors were involved in the final multiple regression model. Patients who received intensive care had lower post-operative Hct values, and the length of post-operative hospital stay was negatively correlated with post-operative Hct.

CONCLUSIONS

Dangerously low post-operative Hct is related to the length of ICU stay and post-operative hospital stay. Age, pre-operative Hct, intra-operative blood loss, post-operative drainage, and units of allogeneic blood transfusion are significant predictors of post-operative Hct and Hct decline. Hct variations during the operation make the calculation of total blood loss difficult.

[Non-cardiac aspects of aortic stenosis in the elderly: A review]

Aortic stenosis (AS) is the most frequent valve disease in the elderly population Treatment is valve replacement either by open surgery, or in the case of patients at high surgical risk, by TAVI (Transcatheter Aortic Valve Implantation). However, almost 40% of patients who have undergone TAVI show poor health outcomes, either due to death or because their clinical status does not improved. This review examines the non-cardiac aspects of patients with AS, which may help answer three key questions in order to evaluate this condition pre-surgically: 1) Are the symptoms presented by the patient exclusively explained by the AS, or are there other factors or comorbidities that could justify or increase them?, 2) What possibilities for improvement of health status and quality of life has the patient after the valve replacement?, and 3) How can we reduce the risk of a futile valve replacement?