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.

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Presentation transcript:

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 Analysis of patients aged under 75 and 75+ undergoing aneurysm repair with and without DHCA Fisher’s exact test

Baseline Characteristics All Aortic Aneurysms Age Less than 75Age 75+ n=974 (%) n=224 (%)P value Age 56±13 79±3< Male 692 (71) 116 (52)< PVD 116 (12) 45 (20)0.002 COPD 70 (7) 19 (8)NS DM 106 (11) 33 (15)NS HT 698 (72) 190 (85)< 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 Age Less than 75Age 75+ n=974 (%) n=224 (%)P value XCT 119 ± ± Elective 547 (56) 130 (58)NS DSI 3 (0.3) 1 (0.5)NS Stroke 51 (5) 28 (13) 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 CPB w/out DHCACPB + 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 CPB + DHCA < 75 CPB + DHCA 75+ n=114 (%) n=35 (%)P value DSI 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