Many people
of that age develop problems with their aortic valve, the "door" to the blood
vessel that transports blood away from the heart. As a result, they are prone
to fatal complications such as congestive heart failure, or sudden death.
Many people
of that age develop problems with their aortic valve, the "door" to the blood
vessel that transports blood away from the heart. As a result, they are prone
to fatal complications such as congestive heart failure, or sudden death.
Surgical replacement of the aortic valve is a relatively common procedure for younger patients. Physicians hesitate to recommend it for patients over 80, however. According to Thoralf M. Sundt III, M.D., many cardiologists fear that elderly individuals either will not survive surgery or that the trauma of surgery will degrade the patient's quality of life. Sundt is first author of the Circulation paper and an associate professor of surgery.
This concern is valid, he said, because surgery is more risky for the elderly. But his study suggests that the benefits might outweigh the risks.
He and his colleagues examined data from all 133 patients age 80 and older who had their aortic valves replaced at the medical school between Jan. 1, 1993, and April 31, 1998. The oldest patient was 91. The researchers contacted most of these patients between July 1, 1998, and Nov. 1, 1999, for questions about recovery and quality of life.
Eleven percent of the patients had died within 30 days of the operation, 80 percent had survived for one year, and 55 percent had survived for at least five years. Quality-of-life scores were roughly the same as those estimated for the general population age 75 and older. Patients who previously had suffered a stroke and patients with chronic obstructive pulmonary disease fared less well than the others.
"Functional outcome after aortic valve replacement in patients more than 80 years old is excellent, the operative risk is acceptable, and the late survival rate is good," the authors concluded.
Quality of life is key for this elderly population, Sundt said. "They don't expect to live forever. But they don't want to be short of breath while climbing stairs or working in the garden," he said. He believes this study provides evidence that aortic valve replacement can significantly improve the lives of these elderly people.
"Although the risks and costs are higher, these people do benefit," he said. Costs are higher because very elderly people often spend longer in the hospital than younger patients undergoing aortic valve replacement.
The researchers now are collecting quality-of-life information from elderly patients both before and after surgery. However, Sundt believes the current publication provides sufficient evidence that the procedure should be offered to patients, regardless of age. "I would like to see all 80-year-olds offered this surgery as a possibility. Then they can make informed decisions," he said.
Sundt also is involved in developing a new Aortic Center at the medical school. The center will focus on thoracic diseases and will serve as a resource for patients in the Midwest to help ensure adequate medical attention and follow-up. For more information, contact Cindy Camillo at 362-8008.
