Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable?

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Neurosurgery

Background:

• Octogenarians undergoing aortic surgery with hypothermic circulatory arrest (HCA) face significant risks.
• Understanding mortality and neurological complications is crucial for this aging population.

Purpose of the Study:

• To analyze the risks of mortality and neurological complications in octogenarians undergoing aortic surgery with HCA.
• To identify risk factors for adverse outcomes in this patient group.

Main Methods:

• Retrospective analysis of 51 patients over 80 years old undergoing aortic surgery with HCA since 1988.
• Multivariate analysis to identify predictors of in-hospital mortality and/or stroke.
• Comparison of outcomes based on surgical approach (median sternotomy vs. thoracotomy) and urgency (elective vs. emergency).

Main Results:

• Overall hospital mortality was 16%, with a 9.8% stroke rate and 22% overall adverse outcome.
• Elective surgery via median sternotomy had a significantly lower adverse outcome (3.6%) compared to thoracotomy (47%).
• Emergency operations and lateral thoracotomy were independent predictors of adverse outcomes (OR 10.6 and 11, respectively). Temporary neurological dysfunction (TND) affected 73% of patients.

Conclusions:

• Aortic surgery with HCA in octogenarians is feasible with acceptable risks, particularly elective procedures via median sternotomy.
• Elderly patients exhibit heightened brain vulnerability, leading to high early mortality post-stroke and frequent TND.
• Emergency operations and lateral thoracotomy significantly increase adverse outcomes in this population.