Heart Surgery Riskier for Those Over 80

Doctors must weigh risks and benefits carefully, researchers conclude

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By Amanda Gardner
HealthDay Reporter

TUESDAY, Nov. 22, 2005 (HealthDay News) -- A new study helps confirm what surgeons have long known: that open-heart surgery poses a greater risk of death and illness for patients 80 years of age or over.

While the finding may impact on the risk-benefit calculation for individuals undergoing coronary artery bypass graft (CABG) surgery or valve surgery, "it certainly doesn't mean that you would deny surgery based on age alone," said Dr. J. Michael Smith, co-author of the study and director of surgical research at Good Samaritan Hospital in Cincinnati.

Another expert said the finding, reported in the November issue of Archives of Surgery, came as little surprise.

"This is not new," said Dr. Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York City. "Even if you have the same risk factors, age is an independent risk factor and physicians are factoring this in."

The number of elderly continues to rise and by the year 2000 there were 4.2 million Americans aged 85 or older. In 2030, this number is expected to reach 8.9 million.

At the same time, the percentage of octogenarians undergoing open-heart surgery for coronary artery bypass grafting (CABG) or valve replacement increased by 67 percent from 1987 to 1990.

About 40 percent of octogenarians have symptomatic cardiovascular disease, including 18 percent with ischemic heart disease. The question for doctors has been whether or not these patients should be referred to either surgery or less-invasive percutaneous procedures.

Coronary artery bypass surgery restores blood flow and oxygen to the heart. Patients with at least one clogged artery may be candidates for the surgery, which involves removing a healthy vessel from another part of the body and using it to make a detour around the blockage.

Valve surgery involves repairing or replacing faulty valves in the heart.

Few other countries perform bypass surgery or other heart interventions on people in this age group. "No question about it, in Europe, India, China, they'll never see the hospital at this age," Sharma said. "Here [in the United States] the family expects it, society expects it."

Sharma himself has performed procedures on five patients over the age of 100: one required angioplasty and four required ballooning of an aortic valve.

In this study, researchers compared octogenarians with non-octogenarians undergoing open-heart surgery for CABG or valve replacement in a community hospital between 1993 and 2001. Of a total 7,726 patients, 522 were octogenarians.

Octogenarians had a 72 percent higher risk of death, 3 percent longer hospitalization, a 51 percent higher risk for neurological complications and were 49 percent more likely to undergo repeat surgery for bleeding.

There were no major differences between the two groups with regard to kidney, lung or gastrointestinal tract complications; readmission to intensive care; or for complications during the operation such as heart attack, hemorrhage and irregular heartbeat.

The message, Smith said, is a mixed one.

On the plus side, surgery can improve quality of life including such symptoms as shortness of breath and chest pain, even in octogenarians. On the other hand, it's hard to make the argument that you will prolong anyone's life this way.

"We don't have data in 80-year-olds to really, really say that we're making people live longer," Smith said.

And if someone that old develops a serious complication from surgery, such as pneumonia or a stroke, they may never recover, Smith added.

The study may also contain an inherent bias: The octogenarians selected for surgery were undoubtedly ones that the surgeons already felt were at low risk for complications. These findings may therefore not apply to all octogenarians equally, Smith said.

More information

To learn more about heart bypass surgery, visit the American Heart Association.

SOURCES: J. Michael Smith, M.D., director of surgical research, Good Samaritan Hospital, Cincinnati; Samin Sharma, M.D., director of interventional cardiology, Mount Sinai Medical Center, New York City; November 2005, Archives of Surgery

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