title: Mortality and neurologic injury after surgical repair with hypothermic circulatory arrest in acute and chronic proximal thoracic aortic pathology: effect of age on outcome.
abstract: BACKGROUND
  The goal of this study was to determine whether advanced age affects mortality and incidence of neurological injury in patients undergoing surgical repair with hypothermic circulatory arrest in acute and chronic thoracic aortic pathology.
  
  
  RESULTS
  A university center audit was done of 523 consecutive patients (median age, 64 years; interquartile range, 56-71 years) between 2005 and 2010. Mortality in acute type A aortic dissection (207 patients) was 9.7%, and in chronic ascending aortic aneurysms (316 patients) was 2.2% (P<0.001). Neurological injury was observed in 16.9% of patients with acute type A aortic dissection (chronic ascending aortic aneurysms, 7.9%; P=0.002). Multivariable regression analysis revealed hypothermic circulatory arrest >40 minutes (odds ratio [OR], 4.21; 95% confidence interval [CI], 1.60-11.06; P=0.004) and redo surgery (OR, 3.44; 95% CI, 1.11-10.64; P=0.03) but not age (OR, 1.98; 95% CI, 0.73-5.38; P=0.18) as independent predictor of mortality. Emergency surgery (OR, 3.27; 95% CI, 1.31-8.15; P=0.01) and extracardiac arteriopathy (OR, 2.38; 95% CI, 1.26-4.50; P=0.008) but not age (OR, 1.80; 95% CI, 0.93-3.48; P=0.08) were independent predictors of neurological injury.
  
  
  CONCLUSIONS
  Age is not associated with increased risk for mortality and neurological injury in patients undergoing surgical repair for acute and chronic thoracic aortic pathology with hypothermic circulatory arrest. Extended hypothermic circulatory arrest times, reflecting the extent of disease, and redo surgery predict mortality, whereas emergency surgery and extracardiac arteriopathy predict neurological injury.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland. martin.czerny@insel.ch
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Eva
authors.initials: E
authors.lastname: Krähenbühl
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.forename: Gabor
authors.initials: G
authors.lastname: Erdoes
authors.forename: Florian
authors.initials: F
authors.lastname: Schoenhoff
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Jenni
authors.forename: Mario
authors.initials: M
authors.lastname: Stalder
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery*; D002493:Central Nervous System Diseases / Q000401:mortality*; D002908:Chronic Disease; D005260:Female; D006324:Heart Arrest, Induced / Q000706:statistics & numerical data*; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008485:Medical Audit / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality*; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data