P-146: Results of geriatric cardiac surgery co-management of older patients with valvular heart disease

Objectives: The growing burden of valvular heart disease (VHD) in older populations demands a substantial change of the current management of this condition. The present work reports preliminary results of a multidisciplinary approach for the care of older patients with VHD. Methods: Data are from an ongoing prospective study analysing clinical outcomes of older VHD patients admitted to the Heart Valve Clinic (HVC) of our Centre. All patients underwent multidisciplinary evaluation including echocardiography, cardiac surgeon consultation, multidimensional geriatric assessment, and neuropsychological testing. Other consultations were performed as needed. Demographic characteristics and clinical outcomes of older VHD patients undergone valve replacement surgery before and after HVC implementation were analysed. Results: Twenty-height older VHD patients admitted to the HVC between April 2014 and February 2015 underwent cardiac surgery. HVC patients were older relative to those treated in 2013 (n=121) (79.1±4.3 vs. 76.5±4.2 years; p<0.01), with no differences in gender distribution, VHD type and severity, NYHA class or number of co-morbid conditions. The total length of hospital stay was unvaried, despite longer time spent in postoperative intensive care unit by HVC patients (159.4±166.7 vs. 86.0±70.0 hours; p<0.001). The number of specialist consultations was reduced after HVC implementation (0.8±1.0 vs. 2.5±1.9; p<0.0001). None of HVC patients died during hospitalisation, whereas 4 patients died in 2013 (p=0.7). Conclusion: The implementation of a multidisciplinary clinical pathway dedicated to geriatric patients with VHD allows extending eligibility to surgery to older and frailer subjects and optimising the use of resources, without impacting mortality or length of hospitalisation.