Outcomes of Elective Aortic Hemiarch Reconstruction for Aneurysmal Disease in the Elderly

This study evaluated outcomes of elective aortic hemiarch reconstruction for aneurysmal disease in the elderly.

Patients undergoing elective aortic hemiarch reconstruction for aneurysmal disease at a single institution between 2009 and 2014 were retrospectively reviewed. Patients were stratified into nonelderly (aged less than 75 years) versus elderly (aged 75 years or more). Outcomes included operative mortality and morbidity.

In all, 629 patients (95 elderly; 15%) were included. Elderly patients had a greater comorbidity burden. Concomitant aortic valve replacement and coronary artery bypass were performed more frequently whereas root replacement was performed less frequently in the elderly. The overall stroke rate was 1.8% and was higher among the elderly (4.2% versus 1.3%, p = 0.05), although this difference no longer persisted after risk adjustment (odds ratio 2.54, p = 0.17). Median length of intensive care unit and hospital stay were longer in the elderly (64 versus 41 hours and 9 versus 7 days, respectively; each p < 0.001). Unadjusted and risk-adjusted operative mortality were similar (2.1% elderly versus 0.9% nonelderly, p = 0.32). Elderly patients were less frequently discharged to home (65% versus 95%, p < 0.001). Propensity matched analysis confirmed these findings. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion was a safe strategy for the elderly patients, with stroke and operative mortality rates of 0% each.

Although elderly patients have a more prolonged recovery after elective aortic hemiarch reconstruction for aneurysmal disease, outcomes are acceptable with low operative mortality and with the majority being discharged home. Moderate hypothermic circulatory arrest with antegrade cerebral perfusion is a safe strategy for this cohort. Advanced age alone should not be viewed as a contraindication in these cases.