Too Old for a Bypass?
No. So why are the elderly turned down for heart surgery?
An Octogenarian Success Story
Case in point: 89-year-old Albert Carlsen, a retired engineer who divides his time between homes in Idaho and Rancho Mirage, Calif. Carlsen underwent a double bypass operation in November at The Heart Hospital of the Desert in Rancho Mirage and has since resumed walking, gardening, and golfing.
"There's obviously some risk when you get up where I am," says the strapping, square-jawed Carlsen. "But heckfire, I went through that operation with flying colors. I was up in three days, dressed, and ready to go home."
A Bypass Believer
Such success stories are the norm for Carlsen's surgeon, Jack Sternlieb, MD, president and founder of The Heart Hospital. "I feel confident in operating on these people," says Sternlieb, who practices in a retirement mecca with a large elderly population. "This operation shouldn't kill you. That's the point."
The average age of his patients who come in for bypass, he says, is 74. Despite the potential risk, Sternlieb says chronological age alone should not be a deciding factor. "Age is not a criterion." (In keeping with his policy, the boyish-looking doctor doesn't reveal his own).
Instead of focusing on age, Sternlieb looks at psychological and social factors: "Does the patient really want to live? Do they have a good appetite? Do they have a support system? At this age, you can't just operate on them and abandon them," he says.
Getting Good Outcomes
Sternlieb is unimpressed with mortality rates reported in the Duke study, saying the numbers are still too high. "If I had mortality rates that high, I'd quit," he says. "It's possible to do this procedure much more safely."
In a recent study by Healthgrades.com, an independent online rating service, Sternlieb's hospital had the lowest in-hospital heart surgery mortality rate in the country, based on 1998 Medicare data. (In-hospital mortality rates include the number of patients who died after the surgery while still in the hospital.) While Alexander of Duke University cites a nearly 20% in-hospital mortality for elderly patients who had combined bypass and valve surgery, Sternlieb's rating for both bypass as well as the combined procedure was zero deaths -- the only cardiac program in the country to make such a claim.