Salem Mohamed, Friedrich Christine, Thiem Alexander, Salem Mostafa Ahmed, Puehler Thomas, Rusch Rene, Berndt Rouven, Cremer Jochen, Haneya Assad
Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105, Kiel, Germany.
Egypt Heart J. 2020 Mar 30;72(1):14. doi: 10.1186/s43044-020-00043-7.
Various studies evaluated the relationship between hypothermic circulatory arrest and neurological outcome in patients undergoing replacement of ascending aorta. The current analysis focuses on the effect of moderate hypothermic circulatory arrest (MHCA) on elderly patients. The aim of our study was to evaluate the impact of MHCA on neurological outcomes in elderly patients undergoing replacement of the ascending aorta.
We retrospectively analyzed 905 consecutive patients, who underwent elective replacement of ascending aorta in MHCA (24 ± 2 °C, nasopharyngeal) between 2001 and 2015. Patients with acute aortic dissection were excluded from this study. Patients were divided into two groups: those aged 75 years and older (elderly group 22.4%, n = 203) and those younger than 75 years (younger group 77.6%, n = 702). The average age was 63.2 ± 10.2 in the young group vs. 78.7 ± 3.0 years in elderly group (p < 0.001). The elderly group had a significantly higher EuroSCORE II [26.7% (18.1, 36.3) vs. 11.6% (7.4, 19.9); p < 0.001)]. The incidence of coronary heart disease (49.8% vs. 35.6%, p < 0.001) and chronic renal failure (17.2% vs. 9.1%, p = 0.001) was significantly higher in the elderly group. Intraoperatively, the time of MHCA [14 min (12, 17) vs. 15 min (12, 18); p = 0.42], cardiopulmonary bypass [139 min (110, 183) vs. 144 min (113, 189); p = 0.225], and cross-clamping [91 min (63, 116) vs. 92 min (65, 127); p = 0.348] was similar in both groups. Postoperatively, a higher incidence of delirium was significantly reported in the elderly group (24.1% vs. 9.0%, p < 0.001). However, there was no significant difference regarding neurological complications between both groups. A 30-day mortality was acceptable for the elderly group, but significantly higher compared with the younger group (7.1% vs. 3.5%, p = 0.031).
Our study suggests that surgical replacement of the ascending aorta in MHCA can also be applied safely in elderly patients without increasing the risk of severe neurological complications.
多项研究评估了升主动脉置换患者中低温循环停搏与神经功能转归之间的关系。当前分析聚焦于中度低温循环停搏（MHCA）对老年患者的影响。我们研究的目的是评估MHCA对接受升主动脉置换的老年患者神经功能转归的影响。
我们回顾性分析了2001年至2015年间连续905例行择期升主动脉置换且采用MHCA（鼻咽温度24±2°C）的患者。本研究排除急性主动脉夹层患者。患者分为两组：75岁及以上患者（老年组22.4%，n = 203）和75岁以下患者（年轻组77.6%，n = 702）。年轻组平均年龄为63.2±10.2岁，老年组为78.7±3.0岁（p < 0.001）。老年组的欧洲心脏手术风险评估系统II评分显著更高[26.7%（18.1，36.3）对11.6%（7.4，19.9）；p < 0.001]。老年组冠心病发病率（49.8%对35.6%，p < 0.001）和慢性肾衰竭发病率（17.2%对9.1%，p = 0.001）显著更高。术中，两组的MHCA时间[14分钟（12，17）对15分钟（12，18）；p = 0.42]、体外循环时间[139分钟（110，183）对144分钟（113，189）；p = 0.225]和主动脉阻断时间[91分钟（63，116）对92分钟（65，127）；p = 0.348]相似。术后，老年组谵妄发生率显著更高（24.1%对9.0%，p < 0.001）。然而，两组神经并发症方面无显著差异。老年组30天死亡率可接受，但与年轻组相比显著更高（7.1%对3.5%，p = 0.031）。
我们的研究表明，在MHCA下行升主动脉手术置换也可安全应用于老年患者，而不增加严重神经并发症风险。
