NEW ORLEANS — Old age is not a reason to deny cardiac surgery to patients.
Patients aged 80 and older who underwent cardiac surgery had a life expectancy that was as good as the current average survival rate for similarly aged people in the U.S. population, according to three separate reports presented at annual scientific sessions of the American Heart Association.
Cardiac surgery “is a viable option for selected patients” aged 80 and older,” Dr. Paul Kurlansky said at the meeting. Chronologic age alone should not be a criterion for deciding whether an elderly patient should be offered cardiac surgery, added Dr. Kurlansky, a cardiothoracic surgeon and director of research at the Florida Heart Research Institute in Miami, who presented one of the meeting reports.
His report reviewed the experience of 1,062 consecutive patients aged 80–99 years who underwent on-pump coronary artery bypass grafting (CABG) during 1989–2001 at Mount Sinai Medical Center, a community hospital in Miami Beach. The average age of these patients was 83. During a mean follow-up of 6 years, actuarial survival following surgery was about 6 years, closely matching the current life expectancy for people aged 80 in the United States.
“Without surgery, their survival would be very short. If survivorship is 5 or 6 years [with surgery], you are offering these patients something that they wouldn't otherwise have,” Dr. Kurlansky said.
In addition, a “very remarkable” finding was how they were doing overall and how they perceived their health. The Short Form-36 health-status questionnaire was completed by 545 of the patients during an in-person or telephone interview an average of 3 years after hospital discharge. The results showed that their self-rated physical- and mental-health scores very closely matched the scores of aged-matched norms for the U.S. population, he reported.
His analysis also showed that during the 12-year period reviewed, the rate of in-hospital mortality in patients undergoing CABG at Mount Sinai steadily fell from a high of nearly 15% in 1989 to a rate of just over 2% by 2001. It is not clear what led to this dramatic increase in perioperative safety, but possible factors are reduced perfusion times, improved anesthesia techniques, and overall better patient care, he said.
The second report at the meeting reviewed 8,796 patients who underwent aortic valve surgery, with or without concurrent CABG, at eight medical centers in northern New England during 1989–2006. This included about 1,000 patients aged 80–84, and about 350 patients aged at least 85.
The median survival rate following surgery was about 7 years in both patients aged 80–84 and those aged 85 and older. Expected survival rates in the general U.S. population inpeople 80–84 is also 7 years, and 5 years for those aged 85 and older, said Donald S. Likosky, Ph.D., a health policy analyst at Dartmouth Medical School in Lebanon, N.H. The survival rates in the elderly cardiac surgery patients were similar whether they underwent valve surgery only or had combined valve surgery and CABG.
The third report at the meeting reviewed 203 patients aged 80 or older (average age 83) who underwent aortic-valve surgery at the Methodist-DeBakey Heart Center in Houston during 1977–2008. A third of the patients also had concurrent CABG. The average perioperative mortality in these patients was about 6%, not significantly different from the average 4% perioperative mortality in 1,020 patients aged 79 or younger (average age 63) who also had aortic valve surgery, and in some cases CABG, at the Methodist-DeBakey Heart Center during the same period, Dr. Gerald M. Lawrie reported in a poster. Dr. Lawrie and his associates did not compare long-term mortality rates in their octogenarian, postsurgical patients with those of age-matched norms.
To see an interview with Dr. Kurlansky, go to www.youtube.com/watch?v=rr-dzV_epv0
Actuarial survival following surgery closely matched the current life expectancy for people aged 80 in the United States. DR. KURLANSKY