18. Common comorbidities in older patients Condition implications Renal dysfunction Exacerbated by diuretics and ACE inhibitors Chronic lung disease Contributes to uncertainty about diagnosis /volume status Cognitive dysfunction Interferes with dietary, medication, activity compliance Depression , social isolation Worsen prognosis, interferes with compliance Postural hypotension, falls Exacerbated by vasodilators, diuretics, ๏ข๏ blockers Urinary incontinence Aggravated by diuretics, ACE inhibitors (cough) Sensory deprivation Interferes with compliance Nutritional disorders Exacerbated by dietary restrictions Polypharmacy Compliance issues, drug interactions Frailty Exacerbated by hospitalization; increased fall risk
Congenital aortic valve (AV) disease. A, A normally functioning bicuspid AV with two commissures and the two leaflets, which are almost equal in size in a 58-year-old man who died of metastatic lung carcinoma. The commissures are located right and left and both coronary ostia arise from the anterior aortic sinus. Note the absence of raphe in either leaflet. The right coronary artery is denoted by an arrow; the left coronary artery is denoted by an arrowhead.
*By KM. Put n= for access complications in TA. Show vascular complication learning slide โ old data vs. SOURCE. We figured it out with TF, now we can figure it out with TA. At 30 days: 369 patients at risk TF; 442 at risk TA At 30 days: TF<20 ES at Day 0 (n at risk 169) at 1 mo (n at risk 138); TF >20 ES at Day 0(281) at 1 mo (n at risk 223) At 30 days: TA<20 ES at Day 0 (n at risk 167) at 1 mo (n at risk 121); TF >20 ES at Day 0(394) at 1 mo (n at risk 312) Vascular complications (major and minor and major alone) not significant predictors of mortality EuroSCORE is significant predictor. See numbers and ROC curve. M&O have requested that we look into technical failure vs. outcome to get to the bottom of the question โIf procedure goes well and patient dies โ why?โ