Clinical outcomes of radiofrequency catheter ablation of atrial fibrillation in octogenarians lO-year experience of a one high-volume center

Background Prevalence of atrial fibrillation （AF） increases with age. Radiofrequency catheter ablation （RFCA） is an establishedtreatment option superior to antiarrhythmics （AAs）. In this study, we investigated safety and efficacy of RFCA of AF in octogenarians.Methods From our database, we extracted procedural and follow-up data for patients 〉 80 years with symptomatic AF undergoing RFCAand compared this population to RFCA patients 〈 50 years. All patients underwent pulmonary vein isolation （PVI） supplemented by linearlesions in PVI-nonresponders. Arrhythmia-free survival was assessed using seven day Holter every three months post procedure. All patientscompleted their 12 months follow-up. Results Fifty patients aged ≥80 years （80.5 ± 1.6 years） were compared to 259 patients aged 〈 50years （43.5±5.5 years）. The RFCA complication rate did not vary between groups. No differences in procedural characteristics were seenafter being analyzed by type of AF. Among patients with paroxysmal AF, 71.4% octogenarian vs. 84.7% young patients was free of anyarrhythmia, without AAs, after single procedure. For non-paroxysmal AF, arrhythmia-free survival without AAs, was considerably lower（58.6% octogenarians vs. 81.2% younger patients, P = 0.023）. If AAs were used, arrhythmia-free survival for paroxysmal AF increased to90.5% and 92.1% in octogenarians and younger patients, respectively; and in non-paroxysmal AF it increased to 79.3% vs. 88.4%. ConclusionsRFCA is a safe and effective strategy to achieve normal sinus rhythm in a highly selected group of octogenarians. Paroxysmal AF ablation inoctogenarians has similar clinical effectiveness as that seen in much younger patients. Non-paroxysmal AF ablation has lower, but still rea-sonable clinical effectiveness.

Percutaneous nephrolithotomy in octogenarians and beyond:How old is too old?

Objective:To specifically report perioperative characteristics and outcomes in patients 80 years and older undergoing percutaneous nephrolithotomy(PCNL).PCNL has been established as feasible in the elderly;however,to our knowledge no one has specifically reported feasibility in patients 80 years and older.Methods:We retrospectively reviewed perioperative data of octogenarians who underwent PCNL at a high stone volume single institution,and matched them to patients<65 years of age by stone burden and sex.Patient demographics,perioperative outcomes and postoperative complications were compared.Results:Thirty-three octogenarians(mean age 83.6 years)with 36 renal units were matched to 67 controls(mean age 48.6 years)with 72 renal units.Octogenarians had a higher mean American Society of Anesthesiologists(ASA)score,more comorbidities,and worse renal function.There were no differences in operative characteristics,length of hospital stay or stone free rates.Of the patients with preoperative urinary decompression(ureteral stent or nephrostomy tube)prior to PCNL,the elderly were more likely to have a history of urosepsis.Octogenarians did not experience more minor Clavien(Ⅰ-Ⅱ)or major Clavien(Ⅲa-Ⅳb)complications.Conclusion:Octogenarians who undergo PCNL were more likely to have cardiovascular comorbidities and a prior history of sepsis.Despite these risk factors,in appropriately selected patients PCNL can be safely and successfully performed in octogenarians without increased perioperative complications relative to a younger cohort.

Steerable microcatheters for complex percutaneous coronary interventions in octogenarians: from Venture to Swift Ninja

0ctogenarians represent the fastest growing group of patients undergoing percutaneous coronary intervention(PCI),now constituting more than one in five patients treated with PCI in real-world practice.[1,2]Comparing coronary lesion characteristics of patients aged<≥80 years to those≥80 years undergoing PCI,the octogenarians have a higher prevalence of calcified and ostial lesions,tortuous coronary anatomy,multi-vessel disease and left main stem(LMS)stenosis.⑶Furthermore,they often have greater ischemic burden than their younger counterparts,suggesting an even greater benefit following revascularization.

Cardiac Surgery in Octogenarians and Beyond: Single Center Experience

Background: Increasing numbers of octogenarians and improvements in surgical techniques and postoperative care have resulted in increasing cardiac operations in this age. The aim is to analyze our experience of cardiac surgery on octogenarians and beyond concerning postoperative morbidities and mortality. Methods: 67 octogenarians and nonagenarians underwent open heart surgery in our hospital between 2001 to 2009 were retrospectively reviewed. Data included baseline preoperative status, intraoperative and perioperative course, and immediate outcomes. Results: The mean age was 86.22 ± 6.1 years. 86.6% patients were males. Symptoms were dyspnea;Class II in 13.4%, Class III in 55.2%, Class IV in 31.4% patients;angina in 82.1%, and CHF in 25.4% patients. The mean EF was 37.8% ± 10. Risk factors include smoking in 52.2%, DM in 37.3%, hypertension in 28.4%, obesity in 25.4%, previous MI in 22.4%, COPD in 17.9%, renal insufficiency in 11.9%, pulmonary hypertension in 7.5%, PVD in 6%, and cerebrovascular disease in 3% patients. The procedures were isolated CABG in 73%, AVR in 9%, MVR in 6%, CABG/valve in 9%, and MVR and AVR in 3% patients. Complications were 18%. It included renal impairment in 18%, arrhythmias in 14.9%, bleeding in 6%, prolonged ventilation in 13.4%, CHF in 4.5%, gastrointestinal bleeding in 4.5%, wound infection in 7.5%, and cerebrovascular accident in 3%. Hospital mortality was 9% patients. Conclusions: Cardiac surgery can be performed safely with acceptable hospital morbidity and mortality in octogenarians and beyond. Early referral and proper selection of patients are mandatory to improve immediate postoperative survival.

Outcomes of elective laparoscopic colorectal operations in octogenarians at a district general hospital in South East England

AIM:To assess the outcomes of laparoscopic colorectal cancer resection in the octogenarian population at our institution.METHODS:Retrospective analysis of registry data accumulated prospectively were used in conjunction with the data obtained from patient notes to identify outcome data for octogenarians who had undergone elective laparoscopic colorectal cancer resection.RESULTS:Laparoscopic colorectal cancer resections were performed in 68 octogenarians between 2003 and 2011 at our institution.Four operations(6%) were converted to an open technique.There were twelve cases of morbidity(18%) and two cases of mortality(3%).The overall median hospital stay was 8 d.The median time for a patient to be deemed surgically fit for discharge was 5 d reflecting a delay in provision of social care or stoma education.CONCLUSION:Our results support the view that laparoscopic surgery in octogenarians is safe,feasible and with a reduced length of stay.This is well reflected in our results which are compatible with United Kingdom national figures.

Evaluation of long stent implantation in diffuse coronary lesions for octogenarians

Objective To evaluate angiographic and clinical outcomes of ≥ 20mm long stents or overlapped stent implantation in diffuse coronary lesions for octogenarians, in comparison with patients under sixty. Methods Two groups (Group O: 47 lesions in 44 octogenarians, aged 81± 3 years; Group Y: 64 lesions in 58 patients under sixty, aged 54 ± 4 years) were compared with a 6-month follow-up. Results Success rate of the procedures was 100%. None had in-hospital major adverse cardiac events (MACE). There was no significant difference in angiographic restenosis between the groups at follow-up (Group O vs Group Y, 29.8 % vs 26.6 %, P = NS). The revascularization of target vessel and MACE was less in Group Y, but these showed no statistical significance (15.6% vs 23.4% and 20.7% vs 25.0%, respectively). Conclusions Long stent implantation for diffuse coronary lesions in octogenarians appears safe and feasible, with high procedural success and favorable long-term outcomes.

Random forests to predict survival of octogenarians with brain metastases from nonsmall-cell lung cancer

Background:To create and validate nomograms for the personalized prediction of survival in octogenarians with newly diagnosed nonsmall-cell lung cancer(NSCLC)with sole brain metastases(BMs).Methods:Random forests(RF)were applied to identify independent prognostic factors for building nomogram models.The predictive accuracy of the model was evaluated based on the receiver operating characteristic(ROC)curve,C-index,and calibration plots.Results:The area under the curve(AUC)values for overall survival at 6,12,and 18 months in the validation cohort were 0.837,0.867,and 0.849,respectively;the AUC values for cancer-specific survival prediction were 0.819,0.835,and 0.818,respectively.The calibration curves visualized the accuracy of the model.Conclusion:The new nomograms have good predictive power for survival among octogenarians with sole BMs related to NSCLC.

Microwave ablation of hepatocellular carcinomas in octogenarians

Aim:To evaluate wether it is safe and meaningful to treat octogenarians with microwave ablation for hepatocellular carcinoma.With an ageing population being healthier than previous generations,old limits for treating disease founded on patient age need to be revised.One of the most common tumour related death causes is hepatocellular carcinoma(HCC).With the development of minimally invasive therapies with curative potential,new ground is being broken offering treatments to older patients in the hope of achieving prolongation and better quality of life.Methods:In this retrospective single centre study of patients having a first microwave ablation therapy for HCC in a national referral centre for ablative liver treatments,septuagenarians(n=161,age 70-80)were compared with octogenarians(n=32,age 80-90).Results:Octogenarians selected for microwave ablation of HCC at a regional multidisciplinary team conference have similar outcomes as their younger control group.Survival,complications and length of stay are not different.Conclusion:Octogenarians who are fit for ablative treatment of HCC should not be disqualified on grounds of age,recognising that this group has an obvious immortality,or lead-time,bias as well as a probable selection bias in part explaining their good results.

Survival after resection of colorectal liver metastases in octogenarians and sexagenarians compared to their respective age-matched national population

Background: The aim of the current study was to investigate survival after resection of colorectal liver metastases (CLM) in octogenarians. The survival of octogenarian patients was compared to the survival of the national population of octogenarians and the survival of sexagenarians, the latter representing the average-age patient undergoing resection of CLM. Methods: Octogenarian and sexagenarian were defined as person 80–89 and 60–69 years of age, respectively. Survival analyses of patients who underwent resection of CLM between 2002 and 2014 were performed. Data from Statistics Norway were used to estimate the survival of the age-matched national population of octogenarians (ageM-Octo) and the age-matched national population of sexagenarians (ageM-Sexa). Results: During the study period, 59 octogenarians underwent resection of CLM. The majority of patients underwent a minor liver resection (n=50). In octogenarians, the 5-year survival was 32.5% and 66.3%[difference, 33.8 percentage points (pp)] in patients and ageM-Octo, respectively. The 10-year survival was 14.1% and 31.2% (difference, 17.1 pp) in patients and ageM-Octo, respectively. In sexagenarians, the 5-year survival was 50.9% and 96.2% (difference, 45.3 pp) in patients and ageM-Sexa, respectively. The 10-year survival was 35.7% and 90.3% (difference, 54.6 pp) in patients and ageM-Sexa, respectively. The 5-year cancer-specific survival and 5-year recurrence-free survival (RFS) after resection of CLM in octogenarians were 43.1% and 32.9%, respectively. Conclusions: After resection of CLM, the survival was poorer in octogenarians than in sexagenarians. However, the difference between the survival curves of patients and their age-matched population was smaller in octogenarians. In practice, this finding may indicate a greater benefit of resection in the elderly than the survival rates alone would suggest.

Clinical efficacy of different treatments and their impacts on the quality of life of octogenarians with coronary artery disease

Background:Coronary artery disease(CAD)in octogenarians(age of>80 years)has a high risk of mortality and high expenses.Research shows that the prevalence of CAD is higher among octogenarians than that among younger people,but few such patients undergo percutaneous coronary intervention(PCI)or coronary artery bypass grafting(CABG).This study aimed to evaluate different treatments w让h respect to their clinical effects and impacts on quality of life of octogenarians with CAD.Methods:Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital,Capital Medical University(Beijing,China)from January 2010 to January 2016 were collected in this study.The patients were categorized into three groups based on the treatments they received:the PCI group(n=292),CABG group(n=110),and medical treatment group(n=117).The followings were recorded during follow-up:clinical data,death(all-cause and cardiovascular-related),re-hospitalization time,Seattle Angina Questionnaire(SAQ)score,and occurrence of hemorrhagic events(cerebral bleeding,gastrointestinal bleeding,and dermal ecchymosis).Results:The median follow-up duration was 25.0(25th,75th percentile:17.0,55.5)months among 417 patients.The all-cause death rates(28.2%vs.12.0%and 14.6%,respectively)and cardiovascular-related death rates(15.4%us.3.8%and 6.4%,respectively)were significantly higher in the medical treatment group than those in the PCI group and CABG group(all P<0.05).The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group(3.8%vs.12.8%and 14.9%,respectively)(x^2=8.23&P=0.018).The SAQ scores of physical limitation,angina frequency,treatment satisfaction,and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group(all P<0.05).No significant difference in the angina stability score was observed among the three groups(F=3.179,P=0.204).Conclusion:PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.

Post-transplant biliary complications using liver grafts from deceased donors older than 70 years:Retrospective case-control study

BACKGROUND The shortage of liver grafts and subsequent waitlist mortality led us to expand the donor pool using liver grafts from older donors.AIM To determine the incidence,outcomes,and risk factors for biliary complications(BC)in liver transplantation(LT)using liver grafts from donors aged>70 years.METHODS Between January 1994 and December 31,2019,297 LTs were performed using donors older than 70 years.After excluding 47 LT for several reasons,we divided 250 LTs into two groups,namely post-LT BC(n=21)and without BC(n=229).This retrospective case-control study compared both groups.RESULTS Choledocho-choledochostomy without T-tube was the most frequent technique(76.2%in the BC group vs 92.6%in the non-BC group).Twenty-one patients(8.4%)developed BC(13 anastomotic strictures,7 biliary leakages,and 1 nonanastomotic biliary stricture).Nine patients underwent percutaneous balloon dilation and nine required a Rouxen-Y hepaticojejunostomy because of dilation failure.The incidence of post-LT complications(graft dysfunction,rejection,renal failure,and non-BC reoperations)was similar in both groups.There were no significant differences in the patient and graft survival between the groups.Moreover,only three deaths were attributed to BC.While female donors were protective factors for BC,donor cardiac arrest was a risk factor.CONCLUSION The incidence of BC was relatively low on using liver grafts>70 years.It could be managed in most cases by percutaneous dilation or Roux-en-Y hepaticojejunostomy,without significant differences in the patient or graft survival between the groups.

Influence of cognitive impairment on cardiac mortality after percutaneous coronary intervention in very elderly patients: a retrospective observational study

Background Cognitive impairment (CI) increases cardiac mortality among very elderly patients. Percutaneous coronary intervention (PCI) for ischemic heart disease (IHD) patients is considered a favorable strategy for decreasing cardiac mortality. Here, we investigated the influence of CI on cardiac mortality after PCI in very elderly patients. Methods We performed a retrospective observational analysis of patients who received PCI between 2012 and 2014 at the South Miyagi Medical Center, Japan. IHD patients over 80 years old who underwent the Mini-Mental State Examination for CI screening during hospitalization and/or who had been diagnosed with CI were included. Participants were divided into CI and non-CI groups, and cardiac mortality and incidence of adverse cardiac events in a 3-year follow-up period were compared between groups. Statistical analyses were performed using the t-test,χ^2 test, and multivariable Cox regression analysis, with major comorbid illness and conventional cardiac risk factors as confounders. Results Of 565 patients, 95 were included (41 CI, 54 non-CI). Cardiac mortality during the follow-up period was significantly higher in the CI group (36%) compared with the non-CI group (13%)(OR = 4.3, 95% CI: 1.56–11.82, P < 0.05). CI was an independent cardiac prognostic factor after PCI and, for CI patients, living only with a CI partner was an independent predictor of cardiac death within three years. Conclusions CI significantly affected cardiac prognosis after PCI in very elderly patients, particularly those living with a CI partner. To improve patients’ prognoses, social background should be considered alongside conventional medical measures.

Bleeding outcomes after non-emergency percutaneous coronary intervention in the very elderly

BackgroundOctogenarians 组成病人为经皮的冠的干预(一种总线标准).MethodsThis 学习评估了的非紧急情况介绍的一个增加的比例在里面医院程序的特征和结果，包括为非紧急情况一种总线标准在 2010 年 1 月和 2012 年 12 月之间介绍给单个大体积的 293 octogenarians 的流血事件第三级的照顾澳大利亚人中心。比较被做， 293 个连续病人，其损害与心肌的梗塞是的 octogenarians.ResultsNon 圣举起被匹配小于等于 60 年变老为在 octogenarians 的非紧急情况一种总线标准的最经常的指示。比作更年轻的队，他们有合作病态和更复杂的冠的疾病的更高的流行，包括更多的类型 C 和钙化的损害。低分子的重量肝磷脂的仙子程序的使用(LMWH；1.0% 对 5.8% ；P < 0.001 ) 并且 glycoprotein IIb/IIIa 禁止者(2.1% 对 9.6% ；P < 0.001 ) 更低，当大腿骨的动脉的存取比在更年轻的病人更通常被使用时(80.9% 对 67.6% ；P < 0.001 ) 。总的来说，向所有流血事件在的更高的发生有一个不重要的趋势老(9.2% 对 5.8% ；P = 0.12 ) 。在存取地点或非存取地点流血和专业或在二个队之间的次要的流血没有重要差别。亚分析没在由 LMWH， glycoprotein IIb/IIIa 禁止者或大腿骨的动脉的存取的使用为率放血上揭示任何重要影响。另外，处于在二 groups.ConclusionsIn 之间的在里面医院死亡，击或尖锐 stent 血栓的率没有重要差别这单个中心研究，我们没包括在经历非紧急情况一种总线标准的 octogenarians 流血的发生在不利在里面医院结果观察重要增加。

Test-retest reliability of the Mini Nutritional Assessment–Short Form(MNA-SF)in older patients undergoing cardiac rehabilitation

Malnutrition is described as a state of insufficient intake of energy,protein and other nutrients leading to changes in body composition(weight loss,reduced fat-free mass)as well as adverse functional and clinical outcomes.[1]Depending on the assessments and definition used,the prevalence in older patients ranges between 12%in communitydwelling adults to 60%of patients in geriatric care facilities.[2–5]Older populations are at high risk of nutritional deficiencies because of risk factors such as multimorbidity,polypharmacy,cognitive and physical decline,poor appetite,depressive syndromes and socioeconomic changes.[4,6].

Heart failure in very elderly population-a profile of heart failure in patients over the age of eighty

Objective Heart failure is an epidemic in the elderly, but there is a striking lack of data in this clinically important patient population. We investigated the demographics, cardiac performance, and medication management of a segment of the hospital popula- tion in at least their eighth decade of life. Methods We retrospectively reviewed 75 records of heart failure patients who were 80 years of age or older. Records were reviewed for demographic information, presence or absence of diastolic dysfunction, evaluation of ejection fraction, and medication usage including angiotensin-concerting enzyme (ACE) inhibitors, angiotensin receptor antagonists (ARBs), beta-adrenergic blockers, digoxin, and aldosterone antagonists. Assessment for contra-indications to ACE inhibitor or ARBs use was also performed to assess co-morbidities that limit treatment of heart failure. Results The population of very elderly with heart failure is heterogeneous. We found a higher proportion of females as well as higher rates of diastolic dysfunction in patients aged ≥ 90 years compared to patients between the ages of 80-89 years. Usage of ACE inhibitors, ARBs and beta-adrenergic blockers was strikingly low throughout the very elderly population. While co-morbid conditions limited use of agents in many cases, there was a lack of explicit contra-indication in most patients not on an ACE inhibitor or an ARB. Conclusions Heart failure is not a single disease processes, but a continuum of disease processes that vary with age. The elderly with heart failure are an undertreated population, in part due to the multitude of co-morbidities that affect them. Further prospective studies are needed to better understand the physiology and ideal treatment regiment in this growing population.

Results of aortic valve replacement for aortic stenosis in patients aged 80 years and older

Purpose: The aim of this study was to investigate our clinical experience in a contemporary series of aortic valve replacement (AVR) for aortic stenosis (AS) with or without coronary artery bypass grafting (CABG), and compare the early and mid-term results between patients aged more than 80 years and those aged less than 80 years. Methods: A retrospective review was performed of 258 consecutive patients with aortic stenosis (AS) who underwent AVR between August 2002 and December 2010 at Juntendo University Hospital. Results: Operative mortality was 7.3% in patients aged 80 years and older, compared with 3.6% in younger patients. Thus, operative mortality was higher in the older patients compared with the younger patients, but was not statistically significant between the two groups. Age more than 80 years was not a predictor of operative mortality. Advanced NYHA class (p = 0.03;odds ratio [OR], 9.5) was found to be a multivariate independent predictor of operative mortality. Patients aged 80 years and older were significantly more likely to suffer from respiratory failure after surgery than younger patients, but there were no significant differences in any other complications between the two age groups. Non-home discharge rate was significantly higher in the patients aged 80 years and older (21.9%) than in the younger patients (5.5%). Three-year survival was 84% in patients aged more than 80 years, and 83% of these elderly patients were living at home at the last follow-up. Conclusions: Patients aged 80 years and older have acceptable results of AVR with slightly increased risk of early mortality and morbidity compared with younger patients.

Impact of age on long term survival following transcatheter aortic valve implantation

Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.

Relationship between Physical Inactivity and Long-term Outcome in Patients Aged ≥80 Years with Acute Coronary Syndrome

Physical inactivity is very common in octogenarians.However,association between physical inactivity and mortality in octogenarians with acute coronary syndrome（ACS） remains unclear.In this study,we aimed to investigate association between physical inactivity and allcause mortality in octogenarian patients with ACS.In this study,we included a total of 353 hospitalized patients,aged ≥80 years,with ACS during the period of 5-year follow-up.The association between physical inactivity and all-cause mortality was analyzed by multivariable Cox aggression.Of the enrolled patients,132（37.4%） were defined as physically inactive,and 221（62.6%） as physically active.Patients with physical inactivity tended to have lower survival rate（21.2% vs.56.5%,P〈0.001） and higher mortality rate（78.8% vs.43.5%,P〈0.001）,and had a worse long-term outcome than those with physical activity（chi-square=27.52,and log rank P〈0.001）.The physical inactivity was still an independent predictor for long-term allcause mortality independent of confounders including age,prior heart failure,stroke,ejection fraction,beta-blocker,clopidogrel and percutaneous coronary intervention（HR：2.35,95% CI：1.26–4.37,P=0.007）.Our study demonstrates that physical inactivity is independently related to increased all-cause mortality in octogenarians with ACS.

OCTOGENARIAN PARTY MEMBER

Nlu Ben, an 83-year-old actor, was encouraged by President Xi Jinping to play a vanguardand exemplary rote as a member of the Communist Party of China （CPC） in a letter on June25.