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Deep Hypothermic Circulatory Arrest in the
Elderly: Is it Safe?
Adam D. Zimmet, Irving L. Kron, Alan M. Speir, Clifford E. Fonner, and Ivan K. Crosby
University of Virginia Health Sciences Center, Department of Surgery, Division of Thoracic and Cardiovascular Surgery, Charlottesville, VA.
Background
• Increasing life expectancy in developed countries with changing indications for cardiac surgery
• Today: More elderly patients undergoing cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA)
Purpose
• To ascertain safety of DHCA in elderly patients undergoing thoracic aneurysm repair
Methods
• Retrospective review of prospectively collected data
• Virginia Cardiac Surgery Quality Initiative (VCSQI) database
Methods
• 1358 patients for study period 2001-2008
• Analysis of patients aged under 75 and 75+ undergoing aneurysm repair with and without DHCA
• Fisher’s exact test
Baseline Characteristics All Aortic Aneurysms
2001-2008Age Less than 75 Age 75+
n=974 (%) n=224 (%) P value
Age 56±13 79±3 <0.0001
Male 692 (71) 116 (52) <0.0001
PVD 116 (12) 45 (20) 0.002
COPD 70 (7) 19 (8) NS
DM 106 (11) 33 (15) NS
HT 698 (72) 190 (85) <0.0001
Renal Failure 40 (4) 8 (4) NS
NYHA III-IV 276 (28) 69 (31) NS
AMI 79 (8) 30 (13) 0.002
Intra- & Postoperative Details
All Aortic Aneurysms
2001-2008 Age Less than 75 Age 75+
n=974 (%) n=224 (%) P value
XCT 119 ± 57 108 ± 52 0.01
Elective 547 (56) 130 (58) NS
DSI 3 (0.3) 1 (0.5) NS
Stroke 51 (5) 28 (13) 0.0003
Reop Bleeding 63 (6) 23 (10) NS
Renal Failure 89 (9) 30 (13) NS
Mortality 82 (8) 31 (14) 0.02
With & Without DHCA
All Aortic Aneurysms
2001-2008CPB w/out DHCA CPB + DHCA
n=136 (%) n=149 (%) P value
DSI 1 (0.7) 0 (0) NS
Stroke 6 (4) 17 (11) 0.05
Reop Bleeding 4 (3) 8 (6) NS
Renal Failure 9 (7) 22 (15) 0.04
Mortality 7 (5) 17 (11) NS
Age & DHCA
All Aortic Aneurysms
2001-2008CPB + DHCA
< 75CPB + DHCA
75+
n=114 (%) n=35 (%) P value
DSI 0 (0) 0 (0) N/A
Stroke 10 (9) 7 (20) NS
Reop Bleeding 6 (5) 2 (6) NS
Renal Failure 16 (14) 6 (17) NS
Mortality 12 (11) 5 (15) NS
Discussion
• Increasing numbers of elderly patients undergoing complex cardiac surgery
– 13.7% mortality rate for age over 75 years undergoing thoracic aneurysm repair
– 12.5% stroke rate
Discussion
• DHCA associated with trend towards increased risk of stroke in patients over 75 years of age
– However no statistically significant differences in rates of reoperation for bleeding, renal failure, and mortality
Conclusion
• Elderly patients at increased risk of death, stroke following thoracic aneurysm repair
• Combined with trend for increased risk of stroke, caution should be used when thoracic aneurysm repair requires DHCA in elderly patients