Many octogenarians leading healthy, active lives after open-heart surgery: study

"I think they were surprised that I made it," Eramian said from her Montreal apartment. "You feel that maybe you're not supposed to be here still, but you are. And I feel as long as I can get around on my own and do my volunteer work, I'm doing OK."

Eramian was among 185 patients, aged 80 to 92, who had open-chest heart-valve repair or replacement surgery and were followed by McGill University researchers to see how they fared over time.

What the researchers found was that many octogenarians not only successfully came through the surgery, but they also added years to their life - and a good-quality life, at that.

The study, presented Tuesday at the Canadian Cardiovascular Congress in Toronto, found that five years after heart-valve surgery, 60 per cent of subjects were alive and 90 per cent of those were leading active, healthy lives.

"The vast majority of the patients that were operated on were autonomous," said senior author Dr. Kevin Lachapelle, a cardiac surgeon at the McGill University Health Centre. "So in other words, they could do their own daily activities themselves - shop, do groceries, take care of work around the house or around their condominium, wherever they were living."

"By and large, the majority of them were at home, rather than living in a nursing setting or in a special residence."

The researchers also measured the seniors' post-surgery quality of life, defined as the ability to participate in leisure activities. Those activities included: social interactions; cognitive tasks such as reading, doing crossword puzzles and working on a computer; and physical pursuits such as walking and gardening.

Lachapelle said a high percentage of study participants were regularly involved in all three types of activities, "which suggests that their psychological well-being and quality of life is fairly good."

Yet he said many octogenarians are not referred by their doctors for an operation because they are considered too old for major cardiac surgery, which typically involves opening up the chest and two to three months' recovery time. Some people suggest that because of their advanced years, such surgery is not a wise use of health-care dollars.

But Lachapelle said the McGill study, and others like it, contradict those contentions.

"What we're saying is age in and of itself is not a contraindication to at least having an appropriate evaluation to see whether they would be candidates for surgery," he said, noting that without the operation, patients' health gradually deteriorates as they go into heart failure and finally die.

"There's no doubt that the time in hospital and so on (after surgery) is longer in these patients, so the costs are going to be higher," he added. "But then again, you have to weigh that cost with the costs of them using health-care resources over a six-month to a year period of time while they linger with heart failure."

Toronto cardiologist Dr. Beth Abramson, a spokeswoman for the Heart and Stroke Foundation, said the findings provide an especially important message, given the greying of Canada's population.

"This study suggests seniors can survive and have dramatically improved longer lives following major cardiac surgery," she said in a statement. "It shows that the elderly can have good outcomes with procedures and clearly shouldn't be denied treatment based on their age alone."

Lachapelle agreed that for a good proportion of the elderly, cardiac surgery could offer a new lease on life.

"Look, we're not going to make them 25," he said. "They're still 82 and 83 years old. But I think for the vast majority of them now, they're able to resume the functioning and autonomy they had before they got sick from their cardiac problem."

"And I think that's what we can hope for."

Eramian, a retired secretary who was widowed in 1975, volunteers at a Montreal seniors residence, takes minutes for meetings of her church's advisory committee and takes part in restaurant outings with a local travel group.

"So I think I'm still doing not bad," she said.

The office of Dr. Patrick Ergina, her surgeon and a study co-author, calls every six months to see how she's managing since her July 2003 operation.

"He just called the other day and I said, 'No, I'm still here."'

"So far, so far. I keep my fingers crossed."