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| AATS/NHLBI: Cardiothoracic Surgery Exploring Collaborative Clinical Research Opportunities |
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Title and Author Research Opportunities for Cardiothoracic Surgery in Aging PopulationsEric Peterson Abstract Older patients an important, different, and under-studied subgroup of those undergoing cardiothoracic surgery. Due to the aging of the US populationand the increased severity ofcoronary and valve disease in older individuals, the use of cardiothoracic surgery in older patients in relative terms is growing rapidly. Between 1990 and 2008, the percentage of all bypass surgery and valve surgery in those aged 80 years or older has more than doubled; from 8 to 16% of total for bypass surgery and from 14 to 30% for valve surgery. Patient's age is certainly relative; more based on one's functional capacity,than on chronologic age. Yet, older aged patients as a group clearly face higher acute risks for complications and death following cardiothoracic surgery. The reasons for this are multi-factorial;in part due to more severe disease, less reserve, and a higher burden of comorbid illnesses. While facing higher treatment risks, older patients may also gain more long-term benefits from surgery due to their more severe disease. Thus, the balance between risks and benefits of surgerymay be different in the older patient than in their younger counterparts. Despite these differences, there are wide gaps in our evidence-base for when and how to perform cardiothoracic surgery in older individuals. The major randomized trials that defined the �standard' for the field (e.g., CASS, VA cooperative, RITA, BARI, STICH) often failed to enroll many if any patients aged 75 years or older. Moving forward, several areas of cardiothoracic surgery are of high priority for future research. First, there should a strong emphasis by NHLBI to have theirsponsored cardiothoracic surgicaltrials and clinical studies be more 'age-representative'. This is particularly true as we move into comparisons of treatments for valvular heart disease. Second, we need the development and evaluation of objective and practical tools for pre-operative risk assessment that can better quantify patients' physiologic status and surgical risk. Third, concern for cognitive decline following cardiothoracic surgery is of particular concern on older individuals. Thus, development and evaluation of therapies and techniques to reduce the cognitive impact associated with surgery is of particular importance for older patients. Fourth, age-related declines in stem-cell mediated repair processes have been documented. Thus, older individuals can also benefit from the NHLBI's growing interest in regenerative mechanisms and therapies. Fifth, there is a general paucity of information on the longitudinal functional outcomes of older patients undergoing bypass and valve surgery. This can be informative for risk prediction, comparative effectiveness research, and for assisting patient and providers make evidence-based clinical decisions. Key Research Gap Requiring NHLBI Leadership Understanding the long-term functional and cognitive outcomes following cardiothoracic surgery and their determinants. Key Citations 1: Pfisterer M, Buser P, Osswald S, et al Outcome of Elderly Patients With Chronic Symptomatic Coronary Artery Disease With an Invasive vs Optimized Medical Treatment Strategy JAMA. 2003;289 (9):1117-1123. doi: 10.1001/jama.289.9.1117 2: Rumsfeld JS, Magid DJ, O'Brien M, et al. Changes in health-related quality of life following coronary artery bypass graft surgery. AnnThoracSurg 2001;72:2026�32. 3: Graham MM, Norris CM, Galbraith PD, et al Quality of life after coronary revascularization in the elderlyEur Heart J (2006) 27 (14): 1690-1698. doi: 10.1093/eurheartj/ehl038 |
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Copyright © 2012 American Association for Thoracic Surgery
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.
All rights reserved. IMPORTANT REMINDER: The preceding information is intended only to provide
general guidance and not as a definitive basis for diagnosis or treatment in any particular case.
It is very important that you consult a doctor about any specific medical problem or question.