NEW ORLEANS — 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, new studies show.
Years ago, physicians "were told we were pushing the envelope" to operate on a 70-year-old, said Dr. Vincent Bufalino, a cardiologist at Loyola University in 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, he said.
Even 90-year-olds are having open-heart surgery, said Dr. Harlan Krumholz, a Yale University cardiologist who has researched older heart patients.
"Age itself shouldn't be an automatic exclusion," he said. Not every older person can undergo such a challenging operation, but the great results seen in the new studies show that doctors have gotten good at figuring out who can.
The studies were reported at an American Heart Association conference this week in New Orleans.
Treatment guidelines by the heart association and other groups do not have age cutoffs for such operations. It has been up to patients, doctors and insurers to decide whether to risk it.
In Florida, Dr. Paul Kurlansky, research director at the Florida Heart Research Institute, led a study of 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001. Average survival was roughly six years — almost the same as similarly aged people who do not have heart disease. Three years after their operations, 90 percent were still alive. Survival improved dramatically as the study went on, from 85 percent in the early years to 98 percent by its end.
Even more impressive: 65 percent survived without any long-term complications — a "very, very remarkable" result, Kurlansky said. Patients also reported a quality of life similar to others their age who did not have bypass surgery.
"What we are really dealing with is chronological age vs. physical age," he said. Many elderly patients are hale and hearty, and if they need surgery, "there's no reason to deny them that."