Abstract
Background:This study was aimed to clarify the characteristics and outcome of elderly patients who had required aortic arch replacement, compared with the younger population. Methods: We performed aortic arch replacement using selective cerebral perfusion in 89 patients between 1992 and 2006, and the patients were divided into two groups (Group O; patients of 70 years or more, Group Y; patients less than 70 years) and reviewed for the characteristics, operative variables, and outcome. The average age was 74±3 years in Group O and 61±9 years in Group Y. Risk factors were analyzed for mortality by forward stepwise logistic regression analysis. Survival curves was evaluated by the Kaplan-Meier methods and evaluated by multivariate Cox regression analysis. Results: Non-atherosclerotic aneurysm (Group O; 27% vs Group Y; 53%, p = 0.02) and redo operation (Group O; 2% vs Group Y; 16%, p = 0.03) were more common in Group Y. Operative time (Group O; 526±97 minutes vs Group Y; 599±165 minutes, p = 0.013) and selective cerebral perfusion time (Group O; 90±23 minutes vs Group Y; 107±34 minutes, p = 0.008) were significantly longer in Group Y. There were no differences in in-hospital mortality (Group O; 8.9% vs Group Y; 4.5%), incidence of postoperative neurological deficit (Group O; 6.7% vs Group Y; 6.8%), and survival rate. The period of respiratory support after surgery was significantly longer in Group O. In addition postoperative neurological deficit (p = 0.008), aortic cross-clamping time (p = 0.025), selective cerebral perfusion time (p = 0.042), redo operation (p = 0.024) were also significant predictors for mortality, and cardiopulmonary bypass time (p = 0.03) and preoperative shock (p = 0.03) were associated with survival rate in Group O. Conclusion: Aortic arch replacement can be performed safely in elderly patients with no significant increase in perioperative morbidity or mortality compared with younger patients. Elective and skillful operation associated with brief period of cardiopulmonary bypass time is required to improve outcome of aortic arch operation in elderly patients.
