Retrograde Arterial Flow In Septuagenarian Aortae From Femoral Cannulation Does Not Increase Peri-operative Embolic Events
Bilal H. Kirmani, Rajani K. Rajnish, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.
Background Femoral cannulation and retrograde arterial inflow for cardiopulmonary bypass is thought to carry an increased risk of disrupting atherosclerotic plaques that have been streamlined for forward-flow. The risks of this are presumed to be higher in older patients where the disease burden has had longer to establish. We sought to compare our outcomes for patients over the age of 70 years with those under 70 years.
Methods We undertook an analysis of our prospective database of minimally invasive surgery on the mitral valve, along with any associated surgery performed through a right mini-thoracotomy. Surgical work-up for all patients included ECG-gated, arterial-phase contrast aorto-femoral CT scan and trans-oesophageal echocardiography to identify intra-luminal atherosclerotic disease.
Results Pre-operative and intra-operative characteristics for 255 patients are outlined in Table 1. Logistic EuroSCORE was significantly higher in the Over70 group (mean 9.5 ± 6.8 vs 2.4 ± 2.7, p<0.001). Between the Over70 and Under70 groups there was no difference in stroke rates (0 (0.0%) vs 4 (2.4%), p=0.37); need for renal replacement (1 (1.1%) vs 1 (0.6%), p=1.0); post-operative inotrope use (30 (33.3%) vs 32 (22.4%), p=0.081) or intensive care length of stay (1.3 ± 2.1 vs 1.3 ± 2.4 days, p=0.95). Donor blood use was higher in the Over70 group (6 (6.7%) vs 2 (1.2%), p=0.044). In-hospital mortality was similar between the two groups (Over70: 3 (3.3%) vs Under70: 3 (1.8%), p=0.15). A larger proportion of patients in the Over70 group required convalescence at discharge (8 (8.8%) vs 1 (0.6%), p=0.003).
Conclusion The risks of retrograde perfusion in selected patients over the age of 70 do not appear to translate to a clinically increased incident of thrombo-embolic complications or in-hospital mortality.
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