A growing number of older Americans are having open-heart surgery, but those 80 and older who have this surgery have a much higher chance of illness and death than younger people.
For example, a U.S. study published late last year found that octogenarians who had open-heart surgery were 72 percent more likely to die, 51 percent more likely to suffer neurological complications and 49 percent more likely to need repeat surgery for bleeding. In addition, they stayed in the hospital 3 percent longer.
The findings didn't surprise experts but rather confirmed what they have long known.
The study included 7,726 people (including 522 octogenarians) who had open-heart surgery -- either for a heart bypass (called coronary artery bypass grafting) or valve replacement or repair -- during an eight-year period. A bypass restores blood flow and oxygen to the heart in people with one or more clogged arteries. Valve surgery is needed to fix faulty heart valves.
Not all findings were negative for older people, however. The researchers found no major differences between octogenarians and younger patients in terms of kidney, lung or gastrointestinal tract complications; readmission to intensive care; or such complications as heart attack, hemorrhage and irregular heartbeat.
The findings, published in the journal Archives of Surgery, offer a mixed message, study co-author Dr. J. Michael Smith, a cardiothoracic surgeon and director of robotic surgery at Good Samaritan Hospital in Cincinnati, told HealthDay.
Open-heart surgery can improve quality of life by relieving symptoms such as chest pain and shortness of breath, he said. However, there's no firm evidence that this kind of surgery actually helps prolong the life of octogenarians.
"We don't have the data in 80-year-olds to really, really say that we're making people live longer," Smith said.
He added that if someone in that age group develops a serious complication from surgery -- such as a stroke or pneumonia -- they may never recover.
Still, though the study's finding may affect the risk-benefit calculation for open heart surgery candidates, "it certainly doesn't mean that you would deny surgery based on age alone," Smith said.
The United States is one of the few countries where heart bypass surgery or heart interventions are done on people 80 and older, noted Dr. Samin Sharma, director of interventional cardiology at Mount Sinai Medical Center in New York City.
"No question about it -- in Europe, India, China, they'll never see the hospital at this age," Sharma told HealthDay. "Here [in the U.S.], the family expects it, society expects it."
He said he's performed heart procedures on five people older than 100: angioplasty in one patient and ballooning of the aortic valve in four others.
The issue of open-heart surgery in older people will probably become more prominent in coming decades. In 2000, there were 4.2 million Americans aged 85 or older; that number is expected to reach 8.9 million by 2030. About 40 percent of octogenarians have symptomatic cardiovascular disease, including 18 percent with ischemic heart disease.
The decision for doctors is whether to recommend that older people have open-heart surgery or less invasive procedures.
Overall, about 666,000 open-heart surgeries -- including bypass procedures, valve replacements and heart transplants -- are performed in the United States each year, according to the American Heart Association.
