Surgery Notes

Octogenarians with blocked arteries or heart valves leaking used to be sent back to their homes by their physicians with only a few pills to try to relieve their symptoms. Are now increasingly being subjected to open heart surgery survival rates are similar to those of much younger patients, new studies show.

Years ago, doctors “were told they were passing the limits” if operating at a septuagenarian, said Dr. Vincent Bufalino, a cardiologist at Loyola University in Chicago. But today “we have strong and mentally alert elderly people” who want to decide for themselves whether to take the risk, he added.

Even nonagenarians are undergoing open heart surgery, said Dr. Harlan Krumholz, a cardiologist at Yale University who has researched elderly cardiac patients.

“Age in itself should not be an automatic disqualification,” he said. Not all elderly may have surgery as rigorous, but the excellent results recorded in new studies show that doctors have made progress in determining who can do it.

The studies were reported at a conference of the American Heart Association this week in New Orleans.

In recent years, surgical techniques, anesthesia and other medical advances reduced the mortality rate. That prompted more doctors to operate on older patients in a series of ailments.

But open-heart surgery is another matter, since it requires opening the heart in an old chest and place the patient on a bypass machine while doctors repair the fragile blood vessels and valves weakened.

Treatment guidelines Heart Association and other groups do not set limits for such operations. Until now depends on patients, doctors and insurers to decide who can be tested.

In Florida, Dr. Paul Kurlansky, director of research at the Heart Research Institute in Florida, conducted a study of 1,062 octogenarians who underwent bypass surgery at Mount Sinai Medical Center in Miami Beach between 1989 and 2001.

The average survival was about six years, nearly the same as the people of similar age who did not suffer heart disease. In total, 90% survived the operation to be discharged. This percentage was significantly improved as the study progressed, 85% in the first year to 98% at the end.

Furthermore, 65% survived with no complications related to surgery without complications and even long term, a “very, very remarkable,” Kurlansky said. Patients also reported a similar quality of life to others of their age who had undergone coronary bypass operations.

“We are really dealing with the physical age versus chronological age,” he added. Many elderly people are healthy and lively, and if they need surgery “no reason to deny them.”

In some cases when the heart suffers pathologies that can not be reversed, the only hope is a transplant. In children, this extreme measure is indicated only in cases where an irreversible disease affecting the central part of the circulatory system and engine.

The vast majority of these situations arising from acquired diseases. The most common are viruses and other diseases that damage the heart muscle, having no chance of recovery. In contrast, few cases in which a transplant is indicated by congenital ailments.

Indeed, congenital heart disease have now the possibility of corrective or palliative surgery. These young patients born with malformed hearts during fetal development, are a very good surgical therapy that allows proper growth and development. Only if the 8 or 9 years his heart muscles reach an irreversible state of malfunction, are candidates for transplantation.

Heart transplantation requires professionals trained in cardiovascular surgery. It is also necessary to have an organization very well assembled, including the detection of a potential donor, the observation of the legal aspects, and the optimal conditions for the transfer of the organ in a timely manner. This is very important, because while surgery is performed in an ablation of the donor heart in another patient must be prepared to receiver.

The speed and coordination of actions is crucial because the success of any transplant relies on the operating organization. Extracted from the donor heart can only be preserved without irrigation for up to four hours.

To be compatible, the donor must be of the same blood group factor receptor and other histocompatibility determinations. Should also take into account age, weight and height. In general, accepts pediatric heart transplant hearts of ages and sizes much higher, since children are receiving an enlarged heart, which has enlarged the chest cavity. Once implanted, the heart muscle continues to develop and adapt to the growth of the receiving body.