8. HYPOTHERMIC CIRCULATORY ARREST IN OCTAGENARIANS
John R. Liddicoat, J. Mark Redmond, Christina M. Vassileva, William A. Baumgartner*, Duke E. Cameron*
Johns Hopkins University Medical Institution
Baltimore, Maryland, USA
BACKGROUND
The number of octagenarians undergoing complex cardiovascular procedures is increasing. Since many of these procedures entail hypothermic circulatory arrest (HCA), this study was conducted to evaluate the risk of stroke and mortality associated with octagenarians.
MATERIAL AND METHODS
Since 1989, 251 adult patients (pts) had cardiovascular procedures involving HCA. Twenty pts were
³ 80 yrs (Group I) and 231 pts < 80 yrs (Group II). We also analyzed 632 pts ³ 80 yrs who underwent cardiovascular procedures since 1989 that required CPB but not HCA (Group III). Neurologic outcomes have been maintained in our database prospectively since 1991.RESULTS
|
|
Group I (HCA ³ 80) |
Group II (HCA < 80) |
Group III (CPB ³ 80) |
|
30-day mortality |
5% (1/20) |
15.2% (35/231) |
8.2% (52/632) |
|
Stroke |
20% (4/20) |
8.8% (18/203) |
6.5% (32/495) |
Three of the four pts in Group I with stroke were discharged from the hospital. All groups had similar ratios of elective cases (Group I: 42%, Group II: 48%, Group III: 45%). The mean ages of Groups I and III were similar (82
± 2 yrs vs 83 ± 3 yrs, P=0.06), and that of Group II was less (59 ± 15 yrs, P<0.001). HCA and CPB times were similar in Groups I and II and the CPB time was significantly longer in Group I (175 ± 31 min) than in Group III (131 ± 52 min, P=0.009). In late follow-up of Group I pts there were three deaths during subacute care, five late deaths (mean: 3.2 yrs, range 1-7 yrs) and nine current survivors (mean: 2.9 yrs, range 0.5 to 10 yrs).CONCLUSION
The use of HCA in octagenarians has low early mortality, moderate risk of perioperative stroke, and satisfactory late survival. Based on these findings, we believe the selective use of HCA is justified in octagenarians.
