1. 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.

2. 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)

3. Purpose To ascertain safety of DHCA in elderly patients undergoing thoracic aneurysm repair

4. Methods Retrospective review of prospectively collected data Virginia Cardiac Surgery Quality Initiative (VCSQI) database

5. 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

6. Baseline Characteristics All Aortic Aneurysms 2001-2008 Age Less than 75Age 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

7. Intra- & Postoperative Details All Aortic Aneurysms 2001-2008 Age Less than 75Age 75+ n=974 (%) n=224 (%)P value XCT 119 ± 57 108 ± 520.01 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

8. With & Without DHCA All Aortic Aneurysms 2001-2008 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

9. Age & DHCA All Aortic Aneurysms 2001-2008 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

10. 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

11. 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

12. 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