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 2001-2008

• Analysis of patients aged under 75 and 75+ undergoing aneurysm repair with and without DHCA

• Fisher’s exact test

Baseline Characteristics All Aortic Aneurysms

2001-2008Age Less than 75 Age 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

Intra- & Postoperative Details

All Aortic Aneurysms

2001-2008 Age Less than 75 Age 75+

n=974 (%) n=224 (%) P value

XCT 119 ± 57 108 ± 52 0.01

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

With & Without DHCA

All Aortic Aneurysms

2001-2008CPB w/out DHCA CPB + 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

2001-2008CPB + DHCA

< 75CPB + DHCA

75+

n=114 (%) n=35 (%) P value

DSI 0 (0) 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