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Published on: October 27, 2020
Hypothermic circulatory arrest in octogenarians: risk of stroke and mortality
J R Liddicoat1, J M Redmond, C M Vassileva
1Division of Cardiac Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
Insights
Deep hypothermic circulatory arrest (DHCA) in patients aged 80+ undergoing cardiovascular procedures shows acceptable mortality but a higher stroke risk. Long-term survival remains satisfactory for this elderly demographic.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Neurological Outcomes
Background:
- Increasing number of elderly patients (80+) undergoing complex cardiovascular procedures.
- Growing need to assess risks associated with advanced surgical techniques in this population.
Purpose of the Study:
- To quantify stroke and mortality risks of deep hypothermic circulatory arrest (DHCA) in patients in their ninth decade.
- To evaluate the safety and efficacy of DHCA in elderly patients undergoing cardiovascular surgery.
Main Methods:
- Retrospective analysis of 251 adult patients undergoing cardiovascular procedures with DHCA since 1989.
- Comparison of outcomes between 20 patients aged 80+ (Group I) and 231 patients <80 years (Group II).
- Inclusion of 632 elderly patients (80+) who had cardiopulmonary bypass without DHCA (Group III) as a control.
Main Results:
- 30-day mortality: 5% (Group I), 15.2% (Group II), 8.2% (Group III).
- Stroke rate: 20% (Group I), 8.8% (Group II), 6.5% (Group III).
- Elderly patients (Group I) had a significantly higher stroke rate compared to younger patients (Group II).
Conclusions:
- Deep hypothermic circulatory arrest (DHCA) is feasible in patients in their ninth decade with acceptable early mortality.
- Elderly patients undergoing DHCA face an elevated risk of stroke.
- Satisfactory late survival rates suggest long-term benefits for carefully selected elderly patients.
Background:
The proportion of patients in their ninth decade of life undergoing complex cardiovascular procedures has increased over the past decade. The purpose of this study is to quantify the potential for stroke and mortality associated with deep hypothermic circulatory arrest (DHCA) in this age group.
Methods:
At our institution, 251 adult patients had cardiovascular procedures that required DHCA since 1989. This included 20 patients 80 years of age or older (group I) and 231 patients less than 80 years (group II). Additionally, we analyzed 632 patients 80 years of age or older who underwent a variety of cardiovascular procedures since 1989 that required cardiopulmonary bypass but not DHCA (group III). Neurologic outcomes have been maintained in our database prospectively since 1991.
Results:
The 30-day mortality in group I was 5%, in group II 15.2%, and in group III 8.2%. The stroke rate was 20% in group I, 8.8% in group II, and 6.5% in group III.
Conclusions:
DHCA can be performed with acceptable early mortality in patients in their ninth decade of life, but they are at an increased risk of stroke. Follow-up shows satisfactory late survival.
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