New York Times, November 11, 2008 - University of Michigan
New York Times, November 11, 2008
Good Survival Rates Found in Heart Surgery for Aged
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By THE ASSOCIATED PRESS
NEW ORLEANS (AP) — Eighty-year-olds with clogged arteries or leaky heart valves used to be sent home with a pat on the arm from their doctors and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, two new studies show.
Years ago, physicians “were told we were pushing the envelope” to operate on a 70-year-old, said Dr. Vincent J. Bufalino, a cardiologist at Loyola University Chicago. But today “we have elderly folks who are extremely viable, mentally quite sharp,” who want to decide for themselves whether to take the risk, said Dr. Bufalino, one of those who reviewed the studies for the American Heart Association.
Even 90-year-olds are having open-heart surgery, said Dr. Harlan M. Krumholz, a Yale cardiologist who has done other research on older heart patients. “Age itself shouldn’t be an automatic exclusion,” Dr. Krumholz said.
Not every older person can undergo such a challenging operation, but the results seen in the new studies show that doctors have become good at figuring out who can.
People 75 and older are the fastest-growing segment of the population, and 40 percent of them have heart disease. Treatment guidelines issued by the heart association and other groups do not have age cutoffs for open-heart surgery. It has been up to patients, doctors and insurers to decide whether to risk it.
In one of the two new studies, which were reported Sunday at the heart association’s conference in New Orleans, researchers led by Dr. Paul A. Kurlansky followed 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001.
Their average survival was roughly six years, almost the same as for similarly aged people who do not have heart disease. Ninety percent survived their surgery to leave the hospital. The rate of such survival improved sharply as the study went on, from 85 percent in the early years to 98 percent by its end. Patients also reported a quality of life similar to that of those their age who did not have bypass surgery.
The second study, by Donald S. Likosky, a researcher at Dartmouth, involved 8,796 elderly people in Maine, New Hampshire and Vermont with leaky aortic valves. The condition can kill within two or three years, and “surgery is their best option” for treatment, Dr. Likosky said.
Six years after valve surgery, sometimes accompanied by a bypass procedure as well, most were still alive. The median survival was seven years, about the same as in the general population of that age. In fact, those in the study who were 85 or older actually outlived their general-population counterparts.
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