Document Detail

Analysis of ascending and transverse aortic arch repair in octogenarians.
MedLine Citation:
PMID:  18721559     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Increasing numbers of older patients are requiring complex thoracic aortic surgery. This retrospective study analyzed early and late outcomes after ascending and transverse arch surgery using hypothermic circulatory arrest (HCA). METHODS: Between January 1991 and December 2006, 779 patients requiring HCA were treated. Outcomes are reported by age group: group 1, 80 years or more (37, 4.8%); and group 2, less than 80 years (742, 95.2%). Univariate and multivariate analyses were used to identify risk factors for morbidity and mortality. RESULTS: Early mortality and stroke did not differ between groups. Thirty-day mortality was13.5% (5 of 37) in group 1 and 10% (78 of 742) in group 2 (p = 0.57). Stroke occurred in 8% (3 of 37) of group 1 patients and 2.7% (20 of 742) of group 2 patients (p = 0.09). Predictors of stroke were prior stroke (p = 0.003) and pump time (p = 0.02). Predictors of early mortality were low glomerular filtration rate (p = 0.0001), long cardiopulmonary bypass time (p = 0.0001), and emergent repair (p = 0.0009). Retrograde cerebral perfusion was protective against stroke (p = 0.0001) and reduced early mortality (p = 0.02). Age was not a predictor of stroke (p = 0.12) or early mortality (p = 0.39). Survival in group 1 compared with the age-matched US population at 1 year was 56% versus 86% (p = 0.02); at 2 years, 48% versus 76% (p = 0.03); at 5 years, 36% versus 48% (not significant); and at 10 years, 20% versus 20%. CONCLUSIONS: Ascending and aortic arch surgery in octogenarians involving profound HCA resulted in reasonable morbidity and short- and long-term mortality rates. The use of profound HCA for aortic surgery remains warranted in octogenarians.
Pallav J Shah; Anthony L Estrera; Charles C Miller; Taek-Yeon Lee; Adel D Irani; Riad Meada; Hazim J Safi
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  86     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-25     Completed Date:  2008-09-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  774-9     Citation Subset:  AIM; IM    
Cardiothoracic and Vascular Surgery, University of Texas Medical School at Houston, Houston, Texas, USA.
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MeSH Terms
Age Factors
Aged, 80 and over
Aneurysm, Dissecting / surgery
Aorta / surgery*
Aorta, Thoracic / surgery*
Aortic Aneurysm / surgery
Cardiopulmonary Bypass
Circulatory Arrest, Deep Hypothermia Induced
Glomerular Filtration Rate
Middle Aged
Postoperative Complications
Retrospective Studies
Risk Factors
Stroke / etiology
Time Factors
Vascular Surgical Procedures / mortality
Grant Support
5 P50 HL083794-02/HL/NHLBI NIH HHS
Comment In:
Ann Thorac Surg. 2008 Sep;86(3):779   [PMID:  18721560 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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