Risk factors of mortality and permanent neurologic injury in patients undergoing ascending aortic and arch repair.
OBJECTIVE
To analyze outcome in elderly patients after surgical repair of the ascending aorta and the aortic arch as compared with their younger counterparts and to determine risk factors of mortality and permanent neurologic injury. Patients and methods Between January 1995 and February 2003, a total of 369 patients underwent ascending aortic and arch repair. Indications for surgical intervention were acute type A dissections in 174 (47%) patients (<75 years, n = 147; > or =75 years, n = 27) and chronic atherosclerotic aneurysms in 195 (53%) patients (<75 years, n = 168; > or =75 years, n = 27). Emergency surgery was performed in 167 (45%) patients; 202 patients (54.7%) underwent surgery requiring deep hypothermic circulatory arrest. Pre- and intraoperative factors were evaluated by means of stepwise logistic regression analysis to determine risk factors of mortality and permanent neurologic injury.


RESULTS
Overall in-hospital mortality was 11.6%. In-hospital mortality with regard to indication for surgical intervention was comparable in both age groups (type A dissection: <75 years, 15.6%; > or =75 years, 18.5%; P =.731; chronic atherosclerotic aneurysm: <75 years, 7.7%; > or =75 years, 7.4%; P =.933). Permanent neurologic injury was observed in 5.0%. Permanent neurologic injury with regard to surgical intervention was comparable in both age groups (type A dissection: <75 years, 8.8%; > or =75 years, 3.7%; P =.359; chronic atherosclerotic aneurysm: <75 years, 3.0%; > or =75 years, 3.7%; P =.843). Stepwise logistic regression analysis revealed preoperative hemodynamic instability (odds ratio 4.3; P =.000), duration of cardiopulmonary bypass (odds ratio 2.1; P =.001), and permanent neurologic injury (odds ratio 1.7; P =.033) but not age as independent predictors affecting mortality. Utilization of but not duration of deep hypothermic circulatory arrest was the only independent predictor of permanent neurologic injury (odds ratio 2.8; P =.019).


CONCLUSIONS
Age shows a trend toward a higher risk of mortality but does not predict a higher incidence of permanent neurologic injury after ascending aortic and arch repair. As utilization of deep hypothermic circulatory arrest remains the only independent predictor of permanent neurologic injury, alternative approaches to maintain cerebral perfusion during ascending aortic and arch repair are warranted.
Czerny
Martin
M
Department of Cardiothoracic Surgery, University of Vienna Medical School, Austria. bypass@eunet.at
Fleck
Tatjana
T
Zimpfer
Daniel
D
Dworschak
Martin
M
Hofmann
Wolfgang
W
Hutschala
Doris
D
Dunkler
Daniela
D
Ehrlich
Marek
M
Wolner
Ernst
E
Grabenwoger
Martin
M
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011336:Probability; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D016019:Survival Analysis; D020196:Trauma, Nervous System / Q000209:etiology* / Q000401:mortality*; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality*