Study's findings are heartening ; Survival odds good for elderly coronary surgery patients
A study of 100 patients aged 85 to 94 who had open-heart surgery found that every one survived the operation. Ninety-three percent survived for at least one month, and the median survival for the entire group was 40 months.
Of the 45 patients researchers were able to contact afterward, 96 percent said they were doing better than before the operation, and all would do it again.
"Most patients return to functional lives," said Dr. Todd Rosengart of Evanston Northwestern Healthcare, lead researcher of the study published this month in the American Journal of Medicine.
The surgeries were done from April 1994 to December 1997 at New York Presbyterian Hospital, where Rosengart worked before coming to Evanston Northwestern two years ago. He said very old patients are having similar outcomes at Evanston Northwestern.
Robert Reneau, 81, of Wilmette recently returned home after a 24-day hospital stay following a coronary bypass and valve repair surgery. "I would have died without it," he said. "Now, I can lead a fuller life than I have in years."
Twenty years ago, surgeons rarely did open-heart surgery on the very old, Rosengart said. But operations on the very old are becoming more common as the population ages and surgical techniques improve.
However, very old patients have fragile heart tissue, and little reserve to survive complications. "You really have to do the operation perfectly every time," Rosengart said.
Rosengart said he generally does not operate on people who are bedridden or have major underlying problems such as lung or kidney disease.
Doctors classify heart patients in four categories, ranging from Class 1 [fatigue after exercise] to Class 4 [can't walk across the room]. The study found that 71 percent of patients improved one class and 25 percent improved two classes.
Before his surgery, Reneau didn't have the strength to play the piano, and was getting weaker by the day from a damaged mitral valve. Doctors warned there was a 5 percent to 7 percent chance he wouldn't survive the operation. Reneau preferred that risk to being an invalid, waiting to die.
Now, he'll be able to resume his daily walks and greeting visitors at the Baha'i House of Worship. He's even thinking of touring Central America with his wife, Rose Marie.
In the study, patients averaged 17 days in the hospital. By contrast, a 60-year-old patient typically is hospitalized for five days.
Open heart surgery can cost $20,000 to $50,000. Doing more surgeries on the very old could increase financial burdens on Medicare, already pinched by increasing health care costs. Some experts have argued that society should set limits on how much money is spent on medical care for the elderly.
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