Kyobu geka. The Japanese journal of thoracic surgery
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Perioperative care for high-aged coronary artery bypass grafting (CABG), thoracic aortic aneurysm and lung cancer is discussed. Among them, each disease has their characteristics and complications. Especially, respiratory, cerebral and cardiovascular complications are common in high-aged patients requiring thoracic surgeries. Careful management is mandatory during these surgeries.
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Operative indications for aortic root reconstruction generally include aortic root aneurysm, root destruction in acute dissection, extensive annular abscess in infective endocarditis, and small aortic annuls. In elderly patients, Bentall operation with bioprosthesis should be one of the standard operation because bioprosthesis in aortic position demonstrated excellent long-term valve durability. ⋯ When aortic valve is nearly normal, valve-sparing aortic root replacement can be an ideal operation without need for prosthetic valve. Indication for valve-sparing operation should be considered when the patient is physically and socially active and does not carry significant comorbidity.
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Aging and advances in medical technology have lead to a rise in the number of patients of advanced age undergoing surgery. This is also observed in thoracic surgery. ⋯ Individual assessment of patients is required to ascertain the organ system capacity and functional reserve. The management of anesthesia is based on the characteristic changes in the elderly, related to physiology and pharmacokinetics, taking account of possible perioperative complications.
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Review Case Reports
[Lung volume reduction surgery for chronic pulmonary emphysema in elderly patients].
We have performed thoracoscopic lung volume reduction surgery (LVRS) for severe chronic pulmonary emphysema irrespective of the patient's age. Between May 1993 and April 2004, 9 patients older than 75 years underwent LVRS at our hospital. ⋯ The other 5 patients showed no clinical improvement after LVRS, 3 of the 5 developed CO2 narcosis and failed weaning from the respirator. Although patient's age older than 75 years is not contra-indication for LVRS, careful selection is needed for LVRS in elderly patients.
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Organ hypofunction by aging exaggerate damages, which are caused by cardiopulmonary bypass. The main cause of organ dysfunction after cardiopulmonary bypass is systemic inflammatory response, which is induced by continuous interaction of blood with unphysiologic surfaces, shear stress to blood cells, and incorporation of abnormal substances. To reduce the postoperative complications after cardiovascular surgery in elderly patients, intensive and careful control of cardiopulmonary bypass and several kinds of anti-inflammatory treatment are important.