Patients in their 80s are can withstand the rigours of open-heart surgery, new Canadian research suggests, as long as they are in good overall health.
In a study of 185 patients who underwent open-heart surgery to replace a heart valve, researchers found that 60 per cent of the patients were still alive five years after surgery, and 90 per cent of those survivors were leading active, independent lives.
The findings should reassure doctors, who often consider age as a factor when deciding if surgery is right for their patients, said study author Dr. Kevin Lachapelle.
"Age should not be a reason for doctors to rule out the possibility of heart surgery for octogenarian patients," Lachapelle, of the McGill University Health Centre (MUHC), said in a statement. "If patients with heart problems are otherwise in good health, this surgery can significantly improve their quality of life."
Lachapelle presents his findings Tuesday at the 2008 Canadian Cardiovascular Congress in Toronto.
It is important for doctors to evaluate the safety and potential benefits of all possible medical treatments to preserve quality of life, Lachapelle said, which is a primary concern for people in their 80s.
Without heart valve surgery, quality of life decreases for many patients as their ability to perform normal daily activities declines.
The study found that more than 90 per cent of the surviving patients were able to live at home or another residence without supervision, while 97 per cent of them were able to engage in social activities.
"Pediatricians account for children's specific needs, as they differ from those of adults," Lachapelle said. "The elderly also have specific issues that must be objectively assessed and not considered based on pre-conceived notions."
Abstract:
Valvular Cardiac Surgery in Octogenarians: Long-Term Outcome and Quality of Life
RK Chaturvedi, B DeVarennes, K Lachapelle
Background: Valvular Heart disease (VHD) in octogenarians is an important problem. Untreated VHD leads to poor quality of life and inability to perform activities of daily living. Increasing age, medical attention and use of investigations such as echocardiography have led to an increase in the diagnosis of VHD in the elderly.
Objectives: The object of this study was to record early and long-term survival, functional status, living arrangements in surviving octogenarians undergoing valve surgery. The second objective of this study was to observe involvement in self motivated leisure activities as an indicator of quality of life.
Methods: All patients aged >80 and undergoing valve surgery between September 2000 and September 2006 were included in this study. The demographic data, pre and post operative data were reviewed. Functional status, living arrangement and leisure engagements were recorded through a telephone interview using items from a standardized questionnaire. Functional outcome was measured using items of the Barthel Index, in order to obtain a Kornofsky performance score. Survivors were divided into 3 categories: Autonomous, Semiautonomous, or Dependant. Living arrangements and engagement in leisure activities within the social, physical, cognitive or creative domains were recorded in an open-ended questionnaire.
Results: 185 patients aged >80 underwent valve surgery. The 30-day mortality was 15.7%. The 1-year survival was 71.4%. After a mean follow-up was 38 (7-78) months, there were 109 (59%) patients who were survived. Seventy-one (65%) of surviving patients were fully autonomous, 28 (26 %) needed minor help and 10 (9%) were dependent. 78 (71.6%) were living at home, 21 (19.3%) living in residences without supervision and 9% lived in supervised settings (home or long-term facilities). Most survivors were involved in social (97%), cognitive (98%), physical (90%) as well as volunteer and creative (17%) leisure activities.
Conclusions: A majority of octogenarians surviving valvular surgery live at home, function independently and are involved in regular leisure activities many years following cardiac surgery. This indicates a good quality of life after their cardiac surgery. This long-term information aid considering risk and benefit of valvular surgery among octogenarians as well as for planning the future need for health care resources.
