Elective hypothermic circulatory arrest to address aortic pathology is safe for the elderly.
BACKGROUND
Due to assumptions of excessive risk, hypothermic circulatory arrest (HCA) has been considered prohibitive in elderly patients. However, as more elderly patients are referred for assessment of difficult aortic valve, ascending aorta, and aortic arch pathology, the risk of HCA in these patients needs to be addressed. We hypothesized that the use of HCA would not increase mortality or complications in elderly patients compared to younger counterparts.


METHODS
We retrospectively reviewed the charts of adult patients who underwent elective HCA between January 1995 and June 2007. Of 147 procedures, 45 patients were >or=75 years old. These patients were compared to their younger counterparts in terms of comorbidities, operations, and complications.


RESULTS
Comparing patients >or=75 years old to their younger counterparts revealed no significant differences in outcomes including nearly identical rates of confusion (>or=75 15% vs <75 9%, p > 0.5) and stroke (>or=75 11% vs <75 7%, p > 0.2). There was also no difference in 30-day mortality (>or=75 7% vs <75 7%, p = 0.9). Lengths of hospital stays and intensive care unit stays were longer in the older patients, but this was not statistically significant.


CONCLUSIONS
In this study, elderly patients faired well with HCA compared to younger patients. These data suggest that the use of HCA is safe in selected elderly patients. Elderly patients should be considered for indicated procedures of the aortic valve, ascending aorta, and aortic arch regardless of age.
Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA. brett.reece@uchsc.edu
T Brett
TB
Reece
Curtis G
CG
Tribble
Benjamin B
BB
Peeler
R Ramesh
RR
Singh
Leo M
LM
Gazoni
Irving L
IL
Kron
John A
JA
Kern
D000367:Age Factors; D000368:Aged; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*