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Too Old for a Bypass?

No. So why are the elderly turned down for heart surgery?

WebMD Feature

June 12, 2000 -- What could be worse than being told you need heart bypass surgery? Being turned down for the procedure because you're too old.

While some surgeons weigh age more than others, conventional wisdom has been that patients over 80 don't fare as well as younger candidates when undergoing cardiac bypass surgery. Now, however, a new study may help to change that thinking and eventually persuade more doctors that age alone shouldn't be a criterion used to deny a heart patient a bypass operation.

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The Key Is Selection

Duke University Medical Center cardiologist Karen Alexander, MD, an assistant professor of medicine, analyzed data from 67,764 patients, including 4,743 octogenarians, and found that carefully selected patients over 80 can weather bypass surgery nearly as well as younger folks.

Octogenarians face added risk when bypass is combined with replacement of the heart's mitral valve, according to the paper published in the March 1, 2000 issue of the Journal of the American College of Cardiology. But the author says patients who have no other risk factors -- such as prior heart surgery or serious stroke -- should be able to withstand bypass surgery and return to a normal life.

The healthiest 80-plus patients in the study who did not have a history of congestive heart failure, lung disease, or vascular disease and who did not need the bypass on an emergency basis did best among the octogenarians.

Overall, 8.1% of octogenarians died in the hospital after bypass surgery compared to 3% of younger patients in the study. But when the healthiest of the elderly patients without the other risk factors were looked at, the rate was 4.2% -- not that much higher than for younger patients undergoing bypass.

In the bypass procedure, veins are removed from the leg or arteries are taken from the mammary arteries in the chest region. These grafts are connected above and below the blockage in the coronary artery (or arteries), bypassing it and restoring good blood flow.

If patients are well selected, even older ones can do well, the study shows.

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