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Should an 87-Year-Old Have Surgery??

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  • Should an 87-Year-Old Have Surgery??

    My mother has been told that she should have her aortic valve replaced, and that unless she does so she has just 3 years to live. She has NO heart symptoms at all -- she fainted a week ago and was worked up and that was when they found the constricted valve -- but she has NO pains, shortness of breath, etc.

    Mom has a wonderful mind still, but her body is failing her. She has lost 5 inches to osteoporosis, she has arthritis, she has trouble exercising. But she loves her life and she has lots of friends and family and a wonderful quality of life in her own home. I am terrified that she is about to throw her remaining good years onto the table (literally) on the chance that she might gain a few extra years beyond 90!

    I have so many questions. Can an osteoporotic sternum and ribs heal properly? How does a frail 87-year-old handle cardiac rehab? What are the risks? We have been told that she has a 1-in-5 chance of DYING ON THE TABLE, and that is not even the worst of it -- she also could have a stroke, a heart attack, and who knows what else as a result of the surgery.

    Does anyone have any experience with a frail elderly person having aortic valve replacement?? I am grateful for anything that you can tell me!

  • #2
    If she is in otherwise fine health, there is no reason that she couldn't forgo this surgery. Only her Cardiologist and Anesthesiologists can make that determination. Did they call God and get the exact date of death if she doesn't do it? They cannot say for sure how long she has if not replaced, but she is showing symptoms, so it could be much sooner then that too. The problem is, our bodies compensate for the valve and we may gradually decline without noticing, but once we've had surgery, there is a huge difference in quality of life. Some people keel over dead and that's their first symptom! Many people have none, but if she fainted, danger is there.

    It's a hard call, but it's possible. The question is, how much quality of life will she gain vs possible problems from surgery?

    Let me say this-Surgery today is highly refined. It is not at all like the days of old. She would have the pro's handling her case and while those risks are very real, very few experience them.

    My second biggest thought=Seek the help of a large, well known institution for her care such as the Cleveland Clinic or Mayo, heck you even have the Texas heart institute near you. Don't let her be a project of the local hospitals.

    http://www.texasheart.org/

    Comment


    • #3
      Ditto

      That about sums it up!
      The first child and the fifth patient to survive heart valve replacement surgery. 51 years and counting since my first HVR!

      Comment


      • #4
        Originally posted by livingfree
        My mother has been told that she should have her aortic valve replaced, and that unless she does so she has just 3 years to live. She has NO heart symptoms at all -- she fainted a week ago and was worked up and that was when they found the constricted valve -- but she has NO pains, shortness of breath, etc.

        Mom has a wonderful mind still, but her body is failing her. She has lost 5 inches to osteoporosis, she has arthritis, she has trouble exercising. But she loves her life and she has lots of friends and family and a wonderful quality of life in her own home. I am terrified that she is about to throw her remaining good years onto the table (literally) on the chance that she might gain a few extra years beyond 90!

        I have so many questions. Can an osteoporotic sternum and ribs heal properly? How does a frail 87-year-old handle cardiac rehab? What are the risks? We have been told that she has a 1-in-5 chance of DYING ON THE TABLE, and that is not even the worst of it -- she also could have a stroke, a heart attack, and who knows what else as a result of the surgery.

        Does anyone have any experience with a frail elderly person having aortic valve replacement?? I am grateful for anything that you can tell me!
        When I was recuperating after having my aortic valve replacement, I had a 90 year old lady become my roommate on my third day of hospitalization. She had an arotic valve replaced at the age of 80, and she was back to see about replacing it again. As it turned out, she had a leaking mitral valve and an abdominal aneurysm, so the doctors were divided about what to do. She wanted to have the surgery. She was still very active and wanted to either regain her health or chance death on the operating table.

        I hoped she wouldn't go through with the replacements. Although she was in good health, I didn't think her body could survive the surgery.

        If it were my mother, I would ask her to reconsider surgery. You can't make this decision for her, but I think you're pretty much on target with your concerns.

        Please let us know what she decides to do.
        Mary

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        • #5
          When my dad was even younger than your mom they told him he would not be a good surgical risk. He also had severe aortic stenosis with some degree of mitral regurg as well. He lived to be almost 90 but the last few months were bad. He had recurring heart failure.
          This is a tough call but I thought my dad made the right decision to live the rest of his life as comfortably as possible and not give up the time he could have by dying on the operating table.
          If your mom is mentally sound, she must make the decision. I would probably steer her away from the surgery and use medication management for the rest of her life.
          Joanne

          Mitral Valve repair Univ of MD hospital 8/15/05
          emergency tracheotomy during surgery.
          11/4/05 implanted loop monitor due to syncope
          1/07 Medtronic implanted pacemaker
          Implanted loop recorder removed after diagnosing the problem.

          Comment


          • #6
            Thank you!! Please tell me:

            Has anyone had any actual experience with aortic valve surgery in an osteoporotic woman past the age of 85?

            How much pain is involved, how well do they mend, how long do they typically have to stay in rehab?

            What difference does her osteoporosis make in the mending of ribs, sternum, etc.?

            How much would being in rehab and in pain for a few months increase her frailty? Increase her chances of a stroke?

            Once discharged from rehab, what percentage return to their homes and what percentage have to go to assisted living or nursing homes?

            If she is without heart symptoms now (other than fainting once), can she be maintained on medication for awhile and buy more time?

            Does it really make sense for a basically well but frail person to have open-heart surgery to fix a problem that is not now bothering her??

            I just keep thinking that the bird of feeling well now is worth a great many of the birds of maybe-being-well-a-little-longer that are supposedly lurking in the beyond-surgery bush....

            Comment


            • #7
              How does your mom feel about it? It is her life. Does she feel that she would like to have this surgery?

              If there is longevity in her family and her genes, she could live for several-many more years. But if she doesn't have the surgery, she may have increasing symptoms and her quality of life will diminish.

              Comment


              • #8
                Originally posted by Nancy
                How does your mom feel about it? It is her life. Does she feel that she would like to have this surgery?

                If there is longevity in her family and her genes, she could live for several-many more years. But if she doesn't have the surgery, she may have increasing symptoms and her quality of life will diminish.
                She isn't sure what she wants to do. How could she know? She has so little information! This is her decision and hers alone... it just must be a FULLY INFORMED decision. I mean, a 20% chance of dying in surgery? Then what is the chance of her living but having a stroke or other surgical complications? Of not healing properly because of her age or osteoporosis? Of surviving but ending up in a nursing home? When we put all of the risks together, does she have a 70% chance of a perfect outcome, or only a 20% chance? That makes a difference!

                On the one hand, she would like to live to be 100. On the other hand, she treasures each healthy day and she doesn't want to live as an invalid. She already has outlived her parents and her brothers, and most of them by decades. Where do we get enough information to help her fully understand what her choices and her risks are??

                Comment


                • #9
                  Well, this is one of those 'between a rock and a hard place' decisions, eh?

                  First off, as Ross said, the docs say three years, but they don't have any sort of crystal ball. She could go earlier or later - who's to say? We all are lucky to wake up each and ever morning, right? And, unless some sort of sudden incident occurs that presses the matter, she would theorhetically have time to see how her symptoms progress.

                  The part of your post that had me most concerned was "her body is failing her. She has lost 5 inches to osteoporosis, she has arthritis, she has trouble exercising." You see, heart surgery is major surgery at any age. And recovering from heart surgery requires things like regular walking and exercise. This is to get lung function back, make sure you don't lie around and catch pneumonia, make sure you don't lie around and build up a blot clot (that could result in a stroke), etc, etc, etc. So, if exercising is hard, and arthritis makes it painful, her recovery could be difficult at best, and turn into a downward spiral at the worst - we have seen it happen.

                  It takes about six months to get the anestesia out of your system and about a year to fully recouperate - fully, fully recouperate - you are certainly up and functioning prior to then. So, she should take that into consideration as well.

                  I guess what I am saying is that, having gone through this surgery, I am not so sure it is something I would be wan to jump into in my twightlight years. If it were me, I would be very, very tempted to tempt fate just a little bit, and take a "watchful waiting approach."

                  Of course, your mother has to decide for herself.

                  Best,
                  Melissa
                  What can you say to make me happy when sad and sad when happy? "This too shall pass. . ."

                  Bacterial endocartitis. Mitral valve repair w/#28 ring, Dr. Delos Cosgrove, CCF
                  8/18/03

                  Comment


                  • #10
                    Should an 87-Year-Old Have Surgery??

                    It's good that you found this website. You need to ask lots of questions and gather all the info. you can, so that whatever decision is made and whatever the outcome, you will feel that you "did the best you could". We all need that when the result is "it's out of our hands". I'm 81 yr. old--just recently posted when the age for surgery poll was listed. I had OHS for mitral valve when I was 79 yr. old. Read Melissa's post referring to the post operative problems about lung function, pneumonia threats, congestive heart failure, blood clots, infections, etc. (all probably of more concern than the actual surgery) There were surely some surprises for me, and I thought I had done my homework well. Will Medicare pay for therapy for rehab? Thought rehab coverage by Medicare was limited to by-pass. Don't want to be negative, because my health is much improved now, but it has taken me more than one year to reach this point. Yes, I have osteoporosis as did my mother before me, but healing of the incision was no problem. My Mom was 89 years old and a nursing home resident when she had gall-bladder surgery. It was an easy decision, because it was an emergency, so that was an easy one. Oh, how we all agonized at the time, so I do understand. She lived about three more years which pleased us more than it pleased her. She was just tuckered out. In the end she just slept away peacefully, and that is every family's wish for their loved ones, right. It's a difficult time in your lives. You deserve much support here and many prayers. Please question all the medical professionals that know her best. If you can keep the emotions out of your questions to them, which can be difficult when it's your MOM, sometimes they will share more of their thoughts--I don't like their predictions of "countdowns" for life expectancy, since I have never met a doctor whose crystal ball was any better than mine.

                    Comment


                    • #11
                      Originally posted by livingfree
                      Thank you!! Please tell me:

                      Has anyone had any actual experience with aortic valve surgery in an osteoporotic woman past the age of 85?

                      How much pain is involved, how well do they mend, how long do they typically have to stay in rehab?

                      What difference does her osteoporosis make in the mending of ribs, sternum, etc.?

                      How much would being in rehab and in pain for a few months increase her frailty? Increase her chances of a stroke?

                      Once discharged from rehab, what percentage return to their homes and what percentage have to go to assisted living or nursing homes?

                      If she is without heart symptoms now (other than fainting once), can she be maintained on medication for awhile and buy more time?

                      Does it really make sense for a basically well but frail person to have open-heart surgery to fix a problem that is not now bothering her??

                      I just keep thinking that the bird of feeling well now is worth a great many of the birds of maybe-being-well-a-little-longer that are supposedly lurking in the beyond-surgery bush....
                      1. I don't know of any, sorry.

                      2. The pain isn't as bad as one would imagine. My hip replacement was much worse. For a woman her age, I don't think rehab is even in the picture. She would most likely be on her own to do the needed excercising that she could do.

                      3. This is a question for an Orthopaedic Doctor. Non of us can answer it.

                      4. I don't see her going to rehab. The pain from surgery in a normal person is gone within 6 months and usually much less. It depends on how well she heals and we just can't predict that. Unless there are complications, stroke risk is very minimal.

                      5. Unless the entire surgery went sour, she would return home in as little as a week after surgery. She will require help though and if there is none, then assisted living is the alternative until she can work for herself again.

                      6. Since she has already had a fainting spell, medications don't really show any promise in extending anything. That was a big DANGER sign or warning to be heeded. Remember, people have keeled over dead without warning or symptoms. She's at least been given warning.

                      7. This goes back to what does she want for quality of life and longevity. Does it make sense? For some, yes it does, but we cannot predict outcomes of surgery for anyone. Everyone is very different. She might well do great and surprise everyone!

                      8. The main concern is the arthritis deal, not the heart surgery. I think you'd be well advised to consult with a Rheumatologist and get his/her opinion on this surgery for a person with her problems.

                      Heart surgery saves lives everyday. It is carried out more and more and things have become almost routine. It's no longer a death sentence and many many people have had better lives because of it.

                      You already know the outcome if nothing is done-Certain death.
                      By having surgery, while it has it's risks, she could conceivably have many years ahead of her so long as she is healthy otherwise. I'm sorry that we can't give you the facts in this case. To be quite honest, stats and facts are really useless since outcomes of individuals cannot be predicted.

                      My first surgery was an emergency. They told me I had a 5% chance of surviving. At the time, that 5% chance was better then the 100% of death if they did nothing. On my second, I was told 50/50 and that is still better then certain death down the road if nothing is done.

                      It's a hard decision and easy for some of us to make, because we don't live with nor know, first hand, what you do about her. The bottom line is, it's going to be her decision and your doing the right thing by educating yourself to relay the info on to her. I only wish we could give you the council your after, but I'm afraid only the professionals can tell you that.

                      You may find something in this reference library that may help you too:
                      http://www.valvereplacement.com/foru...ead.php?t=7027

                      Comment


                      • #12
                        Here is a post that might shed some light, it does involve mitral valve repair, but perhaps there is some info. here that would be useful.

                        http://valvereplacement.com/forums/s...ad.php?t=17051

                        Comment


                        • #13
                          Thanks for all your comments and your prayers!

                          I have just spoken with my mother (I am in TX, and she is in MA). They had scheduled her for surgery today (!), but she has decided to try working with a cardiologist for at least three months. She has no chest pain and no shortness of breath, which she was told would be the two key signs that she had better have the surgery... but today the sun is shining, she feels fine, so we have a little time.

                          My prejudice against the surgery -- I do have one -- is that my family experience so strongly recommends against it. My mother-in-law was told when she was my mother's age (87) that she had to have her aortic valve replaced because it was constricted and also incompetent... but she didn't have it done, and she lived to be 94-1/2, living independently and feeling well except for a little shortness of breath right up until a few months before her death (of heart failure). So I am assuming that my mother may well have a similar 6-7 years or more, without surgery. And both of my sister's in-laws decided in their early eighties to have aortic valve replacement, and both had terrible complications and ended up in nursing homes and died not long thereafter. My sense in reading the posts on this site is that they are skewed toward people who are doing well; so I have a call in to Mom's cardiac surgeon this morning to try to find out about all the possible complications and percentages, etc.

                          Thank you all so much. I will keep checking in. If anyone else finds this thread and knows anyone who has had aortic valve replacement surgery past the age of 85, please let me know how it turned out!

                          Comment


                          • #14
                            Originally posted by livingfree
                            And both of my sister's in-laws decided in their early eighties to have aortic valve replacement, and both had terrible complications and ended up in nursing homes and died not long thereafter. My sense in reading the posts on this site is that they are skewed toward people who are doing well; so I have a call in to Mom's cardiac surgeon this morning to try to find out about all the possible complications and percentages, etc.
                            As I said earlier, surgery TODAY is a completely different ball game then it was back even 10 year ago. From 95 to 02, there have been significant differences in techniques and outcomes and it keeps getting better.

                            We are trying to show that it's impossible to determine an outcome of surgery, so we are not skewed toward people who do well. Some do great, some not so great and some even die. We've had them all here and lived it with them, went to surgery with them, cried with them and their families etc.

                            Your right on cue with the stats and possible complications now. You can always get second and third opinions, but your going to hear the samethings. The only thing not factored into the equation is her bone degeneration problems, in which I would recommend the consult with a Rheumatologist before even considering it. If he/she thinks there will be healing issues, my vote would be no surgery, but if they say it can be done, I would honestly consider it.

                            Comment


                            • #15
                              Having no symptoms doesn't mean that the valve is in good shape. We have many members here who have been given a quick surgery date for a valve that was giving them no symptoms. So don't try to gage how well Mom is doing just on her symptoms, or lack there of.

                              Not having surgery also doesn't mean that one day your Mom will quietly go after having lived her days fully since diagnosis. It could mean that, but it could also mean a slow decline and her seeing her life slowly taken away from her.

                              All that being said, I understand how she and your family sees this as a really tough position to be in. Has your Mom sought a second opinion? I'm sure she would like to be more certain that if she chooses surgery, she'll have a pretty good chance of recovering well. I would hope that she has doctors that would be totally "on the table" about all their thoughts with her.

                              Best wishes to all of you.

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