[Senile alteration of hemodynamics in surgery of abdominal aneurysm]

Hemodynamic measurements were performed before, during and after surgery of aneurysmal patients. Fifty non-ruptured infrarenal aneurysmal patients undergoing elective aortic reconstructions were studied. Patients who had no evidence of heart disease were divided into two groups by age. The older group consisted of 22 patients older than 70 years of age, and the younger group consisted of 28 patients younger than 70 years. The results may be summarized as follows: (1) Hemodynamics before surgery (volume loaded test): For 500 ml albumin infusion within 30 minutes, cardiac indices of the older group kept below 4.0 l/min/m2, whereas in the younger group there was an increase from 3.66 to 4.42 l/min/m2. (2) Hemodynamics during surgery: Peripheral resistance increased by cross-clamping of the aorta, and decreased after removal of the aorta, and decreased after removal of the cross clamp in both groups. Cardiac indices dropped during cross-clamping of the aorta. The older group dropped more noticeably compared with the younger group, for instance, at one minute after cross-clamping, the older group was 2.04 +/- 0.56, and the younger group was 2.44 +/- 0.56 l/min/m2. Mean pulmonary wedge pressure increased gradually during surgery in both groups. (3) Hemodynamics after surgery: The older group kept lower cardiac indices compared with the younger group, but not so noticeably. These results indicated that older patients have low cardiac function for preload and afterload change. We will be confronted by an increasing number of older patients in the near future. Hemodynamic managements of aortic reconstructions in the elderly might become important.