Friday, November 28, 2008
JILL ARMENTROUT
THE SAGINAW NEWS

Dr. Luigi Maresca says biological, not chronological, age determines heart treatment.

Doctors used to send home 80-year-olds with clogged arteries or leaky heart valves with a pat on the arm and pills to try to ease their symptoms. Now more are getting open-heart surgery, with remarkable survival rates rivaling those of much younger people, studies show.

''We totally subscribe to this,'' said Maresca, a cardiovascular surgeon who no longer performs surgery because of arthritis but works with the heart team at the Michigan CardioVascular Institute, 1015 S. Washington in Saginaw.

''This has been our philosophy for a long time. Some people in their 80s are healthier than those in their 40s. They lived well and aren't overweight or smokers -- those people don't live to their 80s.''

Maresca consults with MCVI patients in Saginaw before and after heart surgery.

Not every older person can undergo such a challenging operation, but the great results seen in the studies show that doctors can determine who can.

Scientists reported the studies at an American Heart Association conference last week in New Orleans.

People 75 and older are the fastest-growing segment of the population; this group is projected to more than quadruple over the next 50 years. Forty percent have heart disease, and half will die from it.

In recent years, surgical techniques, anesthesia and other medical care advanced, and death rates fell. That led more doctors to operate on older patients for everything from bum knees to cancer to bad backs.

But open-heart surgery is another thing -- splitting open an aged chest and putting a patient on a heart-lung machine while doctors repair fragile blood vessels and weak valves.

''Older patients are like babies,'' Maresca said. ''They are more prone to complications, so you have to be very careful with their care. Some may not have the support they need at home.

''But this surgery can improve their quality of life. I operated on a man from Saginaw who was 92, and after the surgery, he wrote a book.''

In Florida, Dr. Paul Kurlansky led a study of 1,062 octogenarians who had heart bypass surgery at Mount Sinai Medical Center in Miami Beach from 1989 through 2001. Average survival was roughly six years -- almost the same as similarly aged people who do not have heart disease.

Overall, 90 percent survived their surgery and left the hospital. This improved dramatically as the study went on, from 85 percent in the early years to 98 percent by its end.

Some 65 percent survived without any long-term complications -- a ''very, very remarkable'' result, Kurlansky said. Patients also reported a quality of life similar to others their age who did not have bypass surgery.

The second study involved 8,796 elderly people in Maine, New Hampshire and Vermont with leaky aortic valves. That condition can kill within two or three years, and ''surgery is their best option'' for treatment, said Donald Likosky, a researcher at Dartmouth College in New Hampshire.

Six years after valve surgery -- which sometimes included a bypass -- most still were alive. Median survival was seven years, about the same as the general population of that age.

Those 85 and older in the study actually outlived their general-population counterparts.

Jill Armentrout covers health for The Saginaw News. You may reach her at 776-9681 or jarmentrout@thesaginawnews.com. The Associated Press contributed to this report.