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Original Articles: Adult Cardiac

Invited Commentary

Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114

(Email: tmacgillivray{at}partners.org).

"There is nothing like heart surgery to light every candle on a patient's birthday cake" was the admonition I received as a resident about heart operations for octogenarians. Yet, during the last 15 years, primary heart operations for octogenarians have become commonplace. Many reported series have demonstrated acceptable perioperative mortality, added long-term survival, and improved quality of life for patients in their ninth decade undergoing heart operations. As a testimony to the effectiveness of surgical intervention, surgeons are now consulted to evaluate octogenarians for reoperative heart procedures.

Health care policy decisions regarding how health care dollars should be spent are increasingly topics of discussion. The aging population and escalating health care costs are like two juggernauts on a collision course steaming towards each other at ramming speed. Reoperative heart procedures in octogenarians might seem at first glance to be a frivolous waste of health care dollars. Yet, the article by Krane and colleagues [1] shows that heart reoperations for octogenarians result in similar long-term survival and quality of life compared with primary heart procedures in an age-matched group. The perioperative mortality and need for intraoperative balloon pumps were higher in the reoperative group consistent, albeit higher, with reoperative heart operations in all age groups. During a 12-year period, there were just 71 patients, suggesting that patient selection might play an important role. As this experience grows, it is imperative that we continue to analyze and modify risk models to identify those patients most likely to benefit.

Rationing of care based on the balancing of efficacy and cost may become the future of health care policy. Presently, our role as individual surgeons is to ensure that heart operations remain safe, effective, and beneficial to each of our patients. Age should not be an absolute contraindication to an operation, but rather another consideration that needs to be factored into the risk-benefit assessment. Therefore, it is not the number of candles on the birthday cake that matters; it is whether the patient can blow them out that really counts.

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1. Krane M, Bauernschmitt R, Hiebinger A, et al. Cardiac reoperation in patients aged 80 years and older Ann Thorac Surg 2009;87:1379-1385.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Thomas E. MacGillivray Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by MacGillivray, T. E. Search for Related Content PubMed PubMed Citation Articles by MacGillivray, T. E. Related Collections Coronary disease Valve disease Related Article