Impact of comorbid chronic heart failure with preserved left ventricular ejection fraction on the management of elderly cancer patients before and after total resections

Abstract

To determine the predictors of safe enhanced recovery after surgery in elderly cancer patients with comorbid chronic heart failure (CHF) and preserved left ventricular ejection fraction (LVEF). There were 75 patients over 65 years old (mean 73.6±5.6 years) with cancer of abdominal and pelvic organs and comorbid cardiovascular diseases for the period from January 2018 to July 2020. All patients underwent total resections with enhanced postoperative recovery at the Petrovsky National Research Centre of Surgery. CHF with preserved LVEF was diagnosed in 42 (56%) patients (NYHA class I - 20 patients, class II - 19 patients, class III - 3 patients). ACE/ARA/neprilysin inhibitors were described in 74.7% of patients, beta-blockers - 70.7%, calcium channel blockers - 37.3%, diuretic therapy - 21.3%, antithrombotic therapy - 62.7%, statins - 54.7%, antiarrhythmic therapy - 12%. Preoperative correction of cardiac therapy was required in 60% of patients. Mean LVEF was 58.5±6.8%, pulmonary artery systolic pressure - 29±7.8 mm Hg, impairment of local myocardial contractility was observed in 6.7% of patients. Serum NT-proBNP level was 534.5±63.9 pg/ml, LDL-C - 3.3±1.1 mmol/l, GFR - 65.95±17.1 ml/min/1.73m2, glycated hemoglobin 6.37±0.67%. Perioperative risk of cardiovascular complications within 30-day postoperative period was assessed using the Revised Cardiac Risk Index (RCRI) score (6% in 59 patients, 10.1% in 11 patients, and 15% in 5 patients). Incidence of cardiovascular complications in early postoperative period was 4%, postoperative 30-day mortality rate - 1.3%. Our small study of surgical treatment of elderly cancer patients with comorbid CHF with preserved LVEF demonstrates the need for a personalized assessment of preoperative clinical and instrumental data to optimize cardiac therapy and perioperative monitoring. Multidisciplinary approach reduces perioperative mortality and cardiovascular morbidity from 7.2% to 4%.