Ann Thorac Surg 2008;86:779. doi:10.1016/j.athoracsur.2008.06.003
© 2008 The Society of Thoracic Surgeons
Original Articles: Adult Cardiac
Invited Commentary
Alfred Culliford, MD
Cardiothoracic Surgery, NYU Medical Center, 530 First Ave, Suite 9-V, New York, NY 10016
(Email: alfred.culliford{at}med.nyu.edu).
This article [1] is both timely and pertinent. For more than 15 years, 779 patients required hypothermic circulatory arrest (HCA) to treat aneurysmal disease of the ascending aorta. Of the total 37 patients (4.8%), who were 80 years of age or older, the outcome in this aging group was the focus of this study. Operative technique included central cannulation when possible, profound hypothermic cooling, cerebral monitoring with spectroscopy, and transcranial Doppler studies to confirm adequate cerebral perfusion during cooling, 10-lead electroencephalographic monitoring to determine the time of iso-electric activity and initiation of circulatory arrest (nasopharyngeal temperature of 15 to 20 centigrade, cooling time not specified), and the use of retrograde cerebral perfusion through the superior vena cava during HCA. When the distal anastomosis was completed, cardiopulmonary was re-established with cannulation of the newly inserted Dacron graft. Mortality for the octogenarians is 13.5% compared with 10% for the nonoctogenarians. Of the 37 octogenarians there were 13 acute dissections (mortality, 15.5%), 6 patients with acute rupture and 11 patients required coronary artery bypass grafting. Not surprisingly the median hospital stay was longer for octogenarians (16 vs 13 days) as was the intensive care unit stay (6.5 vs 4 days). For unknown reasons, the late survival was comparable with an age match group of "healthy octogenarians" after the initial 24 months had elapsed. Age was not associated with an increased risk of stroke, whereas it was with prolonged cardiopulmonary bypass time and prior history of stroke. The authors conclude that retrograde cerebral perfusion was protected against stroke; however, because all the patients receive this modality along with the others, the foundation for this conclusion is not apparent. Two findings make this article an important contribution. First, octogenarian patients with ascending aortic aneurysmal disease can be operated on with an acceptable mortality after a standardized protocol and experience satisfactory recovery with moderate morbidity. Second, as the population ages, increasing numbers of older patients will require complex aortic repair and this should no longer be regarded as an insuperable problem.
 |
References
|
|---|
- Shah PJ, Estrera AL, Miller CC, et al. Analysis of ascending and transverse aortic arch repair in octogenarians Ann Thorac Surg 2008;86:774-779.[Abstract/Free Full Text]
Related Article
-
Analysis of Ascending and Transverse Aortic Arch Repair in Octogenarians
- Pallav J. Shah, Anthony L. Estrera, Charles C. Miller, III, Taek-Yeon Lee, Adel D. Irani, Riad Meada, and Hazim J. Safi
Ann. Thorac. Surg. 2008 86: 774-779.
[Abstract]
[Full Text]
[PDF]
Top
References