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Ann Thorac Surg 2000;69:1052
© 2000 The Society of Thoracic Surgeons

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DISCUSSION

Discussion

DR MICHAEL J. REARDON (Houston, TX): John, a very tough group of patients. Do you have any idea how many people in the 80-year-old age group were turned down for surgery as opposed to being accepted, what the real true denominator is?

DR LIDDICOAT: You mean the ones that had hypothermic circulatory arrest?

DR REARDON: No, of the 80-year-olds who might have been candidates for surgery but your group looked at them and said, no, we are not going to operate on this person, we are not going to submit them to hypothermic circulatory arrest.

DR LIDDICOAT: It was difficult to get a feel for that. I spoke to the surgeons covering the service during that time, and none of them had a recollection of a case that was refused because of age. Thus, it seems they consistently underwent surgery.

DR THORALF M. SUNDT III (St. Louis, MO): Some surgeons have advocated using profound hypothermia and circulatory arrest to replace the ascending aorta in individuals with severe atherosclerotic disease of the aorta, with the aim of reducing neurologic events. Obviously, this will be seen most often in the older age group. Does your finding of a pretty high stroke rate in the elderly influence your attitude towards embarking on replacement of the ascending aorta as a prophylactic procedure?

DR LIDDICOAT: It certainly has, and it has generated a lot of discussion. Currently, the patients who we operate on for coronary artery disease and are found to have severe atherosclerosis affecting the ascending aorta are managed with off pump coronary artery bypass grafting. The proximal anastomoses are performed at an alternative site such as the pedicled internal mammary artery. It is obviously more difficult with valve surgery because your options are limited.

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