Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable?

Objective: This study was undertaken to analyze the risk of mortality and n eurological complications after aortic surgery requiring hypothermic circul atory arrest (RCA) in octogenarians. Methods: All patients of >80 years at the time of aortic surgery requiring HCA since 1988 were examined. Of 51 pa tients, 23 were male; the median age was 83. Twenty-six (51%) had proximal repair; the arch was replaced in eight (16%), and 17 (33%) had descending a orta repair. Eleven (22%) were emergencies. Multivariate analysis was carri ed out to determine the risk factors for in-hospital mortality and/or strok e (adverse outcome) using variables with P < 0.1 after univariate analysis. Results: The hospital mortality was 16%. Five patients suffered strokes (9 .8%): only one survived >6 months, and three died before discharge. The ove rall adverse outcome was 22%, but elective operation was associated with mu ch better results, with an adverse outcome of only 3.6% after operations vi a a median sternotomy. Adverse outcome was strikingly higher with more dist al resections via a left thoracotomy: 47 vs. 8.8% for ascending aorta/arch resections (P = 0.003). Emergency operation via a lateral thoracotomy was a ssociated with a prohibitively high adverse outcome. Twenty-nine patients ( 73%) had temporary neurological dysfunction (TND). Multivariate analysis re vealed emergency operation (P = 0.01; adds ratio (OR), 10.6) and operations via a lateral thoracotomy (P = 0.008; OR, 11) as independent preoperative predictors of adverse outcome. The overall survival was 66% at 2 years and 39% at 5 years, compared with 85 and 52% among age- and sex- matched contro ls. Conclusions: Aortic surgery utilizing HCA in octogenarians can be perfo rmed with an acceptable risk of mortality and stroke. From the evidence in this study, it seems that elective aneurysm repair via a median sternotomy can be undertaken for the usual indications, even in octogenarians. However , the enhanced vulnerability of the brain in the elderly is reflected by a high early mortality following stroke, and a high incidence of TND. Emergen cy operations increase the possibility of adverse outcome dramatically, and patients who require a lateral thoracotomy are at significantly higher ris k than those operated via a median sternotomy. (C) 2001 Elsevier Science B. V. All rights reserved.