Should an 87-Year-Old Have Surgery??

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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!
 
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/
 
livingfree said:
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
 
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.
 
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....
 
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.
 
Nancy said:
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??
 
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
 
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.
 
livingfree said:
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/forums/showthread.php?t=7027
 
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!
 
livingfree said:
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.
 
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.
 
There is a method of surgery called HeartPort surgery, Joe had that with his last surgery.

It does not go through the sternum, but goes instead through the side and lung. So it is just soft tissue healing, not bone healing. I believe that now something like that can be used both for the mitral and aortic valves.

Not every patient is a good candidate for it, not every hospital does it and not every surgeon does it. But it is well worth looking into.

The recovery time after this surgery is a little faster, since there is no bone healing. There is still pain as one would expect.

Joe did very well with it. His mortality/morbidity rate for his last surgery was 15% to the bad, since it was his third heart valve surgery. He's still here, and he's 75.

http://www.corvascmds.com/cardiac_surgery_heartport.htm
 
Mitral valve surgery carries a higher risk for elderly patients, but even it has changed dramatically!

Cardiac surgeons often shy away from repairing or replacing leaking mitral valves in elderly patients because of a historically high death rate and mediocre long-term survival. However, Mayo Clinic researchers found that the operation’s death rate for patients over age 75 fell dramatically from 27 percent to 5 percent between 1980 and 1995.

“We want to dispel the message of gloom and doom that is given to older people,” said Maurice Enriquez-Sarano, M.D., senior author of the study. “We may not make people live forever, but we can restore life expectancy in a similar manner in younger and older patients.”


http://www.brightsurf.com/news/head..._may_be_safe_option_for_elderly_patients.html

Q. Is there an age limit for cardiac surgery?
A. Not in my book. A 65 year old may have the heart of an 85 year old and vice versa. The oldest patient I've operated on is 95. So many factors are involved, including the patient's current level of activity, and overall health and appearance.

http://www.dh.org/medical/heartcenter/openheart_surgery.htm

One expert agreed. "Elderly patients should not let age be a barrier to getting treatment for mitral valve prolapse," said Dr. Eugene A. Grossi, a professor of cardiothoracic surgery at New York University School of Medicine and director of NYU's cardiac surgery research. "Patients should have the operation before co-morbidities like heart failure develop."

Grossi noted that he is seeing more elderly patients and expects the trend to continue as the population ages. In addition, his study of 700 elderly patients undergoing a similar procedure, called aortic valve surgery, turned up similar results.

According to Grossi, patients in their 80s and even in their 90s can have good outcomes and resume an active lifestyle. "The point of doing the surgery is not to extend life, but to restore quality of life," he said.

Another expert thinks that older patients who need the surgery should consider it because of the better outcomes seen now.

"It goes against the frequent belief that older patients have less to gain from an invasive procedure," said Dr. Byron K. Lee, an assistant professor of cardiology at the University of California, San Francisco. "In this study, life expectancy following valve surgery is shorter for the elderly, which is expected. The elderly are more likely to die of other diseases than younger patients," Lee said.

However, the study indicates that the elderly are just as likely as younger patients to return to the same life expectancy as their peers, Lee added. "Perhaps, that is important for patients to consider when deciding on surgery. They are just as likely as younger patients to get back to living as their friends in their same age group."

http://www.sw.org/sw/portal/.cmd/SW...em.jsp/.swkey/HSNI_533817/.piid/152/.ciid/253
 
Ask for the results of whatever tests were run on her.
If she has a stenotic aortic valve, what is the opening?
They've given her three years to live; I doubt that the valve opening could be really small if they're giving her a three year time frame.
When you talk to the cardiologist, tell him you want to know the results of her echo. Then come back and post them here.
No one should be making judgments either way until you find out some more values.
 
livingfree said:
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!

My sister has a former co-worker whose mom -- age 90 -- had AVR within the past year. She was in bad shape pre-op, which lengthens recovery (been there, done that!), and was told chances were no better than 50-50 that she'd make it out of surgery.
She had surgery at a hospital in Denton Texas (I've seen Presbyterian Hospital of Denton near the junction of Interstates 35E & 35W there, so maybe that's where she had the surgery). She did marvelous. A true miracle, you might say.
She got a porcine valve, I think it was, and did NOT have to go to a rehab center. A family member stayed w/ her about 1 week and then she shooed them out. Neighbors did check on her every day. She did well with cardiac rehab, I'm sure it was a modified program for people her age.

My grandmothers lived to be 96 & 99.5 years of age. My parents are 77 & 79.
I'll go to my cardio at least annually for the rest of my life. If it looks like I need VR again, I'll cross that bridge long before I come to it.
 
Hello 'Free' =

As you've seen, it's not an easy call.

It would help to know the condition of her valve, especially the size of the Aortic Valve Opening.

Most surgeons use 0.8 sq cm and smaller as a 'trigger point' for recommending surgery.

Sudden Death with exertion is a possibility when the valve opening becomes small. (e.g. those basketball players who drop dead on the court). And it is NOT uncommon for patients to have NO symptoms even with seriously compromised valves. That's why the Echocardiogram Test numbers are so important to know.

I would recommend getting opinions from at least TWO Valve Surgeons AND two Bone Surgeons.

Your commend that she does not tolerate exercise well concerns me because Exercise is the KEY to recovery. Walking progressively longer and faster builds up the muscles and breathing capacity.

FWIW, I've had two Heart Surgeries, the first for bypass and the second for Aortic Valve Replacement. After the second surgery, progress was SLOW but steady for a full YEAR and a HALF when I felt I had finally reached my full recovery potential and was able to hand saw trees and push mow 2 acres. (I was in my 50's at the times of surgery).

Oh yes, PAIN is generally NOT an issue. For both of my surgeries, it was more a matter of 'discomfort' than pain, except the second time around I did have MUSCLE Pain from being stretched open so far. MASSAGE worked much Better and Faster than any pain medication for those muscle pains.

FWIW, an 81 year old inactive neighbor had bypass surgery at the same hospital as I used but never really recovered. Part of the reason was that he just didn't do the walking exercises he needed to regain his strength and breathing capabity. I think he kept waiting 'until he felt better' to be more active. It just doesn't work that way. He died 2 years later.

I recall two Boston hospitals (Women's ??? and ???) that seem to be well regarded. Hopefully someone from the area can give you more insight.

I was hoping that Marty would comment. He is a Physician who had valve replacement at age 75 and is still working half time so he may be a good proponent in the YES category.

With your mother's condition, it's a highly individual decision. Hopefully with enough research and medical opinions you and she will arrive at a decision that is comfortable and acceptable. Take the time to make a fully INFORMED decision.

'AL Capshaw'
 

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