The American journal of cardiology
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Comparative Study
Increased complications and prolonged hospital stay in elderly cardiac surgical patients with low serum albumin.
Cardiac surgery in elderly patients is associated with acceptable operative mortality but an increased complication rate. Malnutrition is common in the elderly and may adversely affect surgical outcome. To determine the effect of hypoalbuminemia on postoperative complications, 92 patients greater than or equal to 75 years (range 75 to 90) undergoing a variety of major cardiac surgical procedures were evaluated. ⋯ Using multivariate analysis, albumin less than 3.5 g/dl was the most powerful predictor of postoperative renal dysfunction (p less than 0.01), and was also an independent predictor of increased length of stay (p less than 0.01) and gastrointestinal disorders (p less than 0.05). Thus, hypoalbuminemia is a powerful indicator of an increased risk of perioperative complications in elderly patients undergoing cardiac surgery. Increased attention to nutritional factors is warranted in these patients.
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The feasibility and potential adverse effects of using intraoperative transesophageal echocardiography (TEE) in 19 children ages 7.5 to 16 years undergoing surgical repair of a variety of congenital heart defects were evaluated. The ability of TEE to assess the adequacy of surgical repair as well as left ventricular function and wall motion abnormalities in this setting was also examined. Intraoperative transesophageal 2-dimensional and Doppler evaluation, and, in selected patients, echo-contrast and color flow imaging, were performed with either a 3.5- or 5.0-MHz phased array probe mounted within the tip of a flexible gastroscope. ⋯ No patient displayed any adverse neurologic effects. It is concluded that, with the currently available probes, intraoperative TEE can be performed safely and reliably in children as young as 7.5 years of age. The procedure provides valuable information regarding wall motion abnormalities, cardiac function and the adequacy of surgical repair.