Quality Of Life After Open Heart Surgery In Older Patients
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| First Posted : November 4, 2005Last Update Posted : January 20, 2017 |
- Study Details
| Procedure: Cardiac Surgery |
| Study Type : |
| Quality of Life After Open Heart Surgery in Older Patients |
| Study Start Date : |
- Coronary artery bypass graft surgery, aortic valve replacement, mitral valve replacement, aortic aneurysm repair
Information from the National Library of Medicine
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.
| Ages Eligible for Study: | 90 Years and older |
| Sexes Eligible for Study: | |
| Non-Probability Sample |
Inclusion Criteria:
- Patients who underwent open heart procedures and who were 90 years or greater between 1995 and 2004 at The New York Presbyterian Hospital
Exclusion Criteria:
Why Would You Need Heart Reoperation Surgery
There are several reasons why you may need a second heart operation.
1. Its been awhile since your first surgery
If you had coronary artery bypass, you may find that you need a second surgery later in life because of new disease in your own vessels or disease that has developed in your bypass grafts. How long a coronary artery bypass lasts depends on a number of things, including:
- Type of bypass used
- Quality of the coronary arteries being bypassed
- Risk factors
- Genetic tendencies
2. A valve repair or replacement fails
If you had a heart valve repair or replacement, the operation sometimes needs to be repeated. Repairs are typically chosen over replacement because of the prospect for longer durability.
Depending on the reason for the first repair, sometimes the valve itself will still degenerate over time. Similarly, tissue replacement valves are known to wear out over time and even mechanical valves can develop later problems that may require a reoperation.
For example, the valve might start to leak or allow blood to flow backwards . This impairs your heart function. We can often repair the valve again to achieve the outcomes that we hoped for in the first surgery, or we can replace the valve.
3. Complications develop
If you develop an infection or other complications from your initial surgery, you may need a second heart surgery. These reoperations are particularly difficult and should be addressed by a team familiar with the safest techniques for successful treatment.
How To Prepare For Open
Tell your doctor about any drugs you are taking, even over-the-counter medications, vitamins, and herbs. Inform them of any illnesses you have, including herpes outbreak, cold, flu, or fever.
In the two weeks before the surgery, your doctor may ask you to quit smoking and stop taking blood-thinning medications, such as aspirin, ibuprofen, or naproxen.
Its important to talk to your doctor about your alcohol consumption before you prepare for the surgery. If you typically have three or more drinks a day and stop right before you go into surgery, you may go into alcohol withdrawal. This may cause life-threatening complications after open-heart surgery, including seizures or tremors. Your doctor can help you with alcohol withdrawal to reduce the likelihood of these complications.
The day before the surgery, you may be asked to wash yourself with a special soap. This soap is used to kill bacteria on your skin and will lessen the chance of an infection after surgery. You may also be asked not to eat or drink anything after midnight.
Your healthcare provider will give you more detailed instructions when you arrive at the hospital for surgery.
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Details About The Studies
Two separate studies presented at the March 2019 American College of Cardiology conference supported similar findings: After one to two years of follow-up, TAVR outcomes were found to be similar to surgical aortic valve replacement outcomes in patients with aortic stenosis and low surgical risk.
In a TAVR procedure, a doctor can repair a diseased aortic valve without open heart surgery. The new heart valve is inserted via catheter through an incision in the groin, guided inside the affected valve, and expanded to reopen it. Approximately half of patients with aortic stenosis today are considered to have low surgical risk hence the excitement about those studies.
Medtronics trial studied the CoreValve platform. Researchers assessed two endpoints after two years: death and disabling stroke. This study found that 5.3 percent of patients who had TAVR died or suffered a disabling stroke compared to 6.7 percent of patients who had surgery. All-cause mortality rates were the same for both procedures. Disabling stroke affected 1.1 percent of TAVR patients and 3.5 percent of surgery patients. The mean age of participants was 74.
The two competing medical device companies have both since published two-year results, which are in line with the initial reported findings.
How Long Is A Person Expected To Live After A Bypass Operation
The life expectancy after coronary bypass surgery depends again on the individuals risk factors. And most importantly, on the ventricular function, how well the muscle of the heart works. If the tissue in the centre works well, the life expectancy can be approximately what the healthy population is whove never had a heart attack. On the other hand, people with advanced left ventricular dysfunction that means, whove had significant damage to the main pumping chamber of the heart their life expectancy is more limited.
Lets summarise the article so far. If a patient has a LIMA bypass, it is almost 90% likely to remain open, even ten years after the operation, and that is just great. For the other blockages where an SVG graft is used, the bypasses are about 50% likely to remain open at ten years. If grafts go down its not necessarily a disaster, there are often good treatment options.
Remember that the bypass was done to treat coronary artery disease, but thats only half the battle. The same disease process still goes on despite the bypass, and so the emphasis in these patients should be on treatments that can act to stabilise the heart disease. These treatments include medications, blood pressure control, cholesterol management, avoiding smoke, exercise, diet, and the adoption of a healthy lifestyle. Now, these are the truly life-saving measures.
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What It Means For Australians
It dropped because people were being directed towards less invasive alternatives such as angioplasty, which uses a tiny balloon to widen an artery and stenting, which places a small wire mesh tube in the artery to keep it open.
In Australia it is not unusual for bypass patients go on to have the procedure redone a second or even third time. Nic Walker
But there remain several reasons why some still have CABG. These include blockages at multiple sites, or in the left main coronary artery or its equivalent.
So what does this new study mean for Australian patients?
Professor Robert Graham, executive director of the Victor Chang Cardiac Research Institute in Sydney, says: “The Danish data is very believable but it’s hard to know if the rise in mortality is due to aging or to the bypass surgery.”
He says its application is limited because many of those who had a bypass 20 or 30 years ago would have stenting today.
Further, in Australia it is not unusual for bypass patients go on to have the procedure redone a second or even third time, although this can become progressively more difficult to do.
He says these days more patients are also opting for minimally invasive CABG. Rather than having conventional open heart surgery, for which the breastbone is sawn in half, they have robotic surgery.
While this involves small cuts in the chest and a shorter hospital stay, it is mostly used for people who need only one graft.
If the flow is strong, the graft will last a long time.
How Is A Heart Valve Replacement Surgery Performed
Heart valve replacement surgery can be performed via any of the two approaches:
- Open-heart surgery: Traditional method of heart surgery in which a large incision is made in the chest the heart is stopped for a time so that the surgeon can repair or replace the valve.
- Minimally invasive heart surgery: These are the newer techniques in which the doctors make smaller incisions over the chest to replace the heart valves.
The diseased valves may be replaced by any of the artificial valves that include:
- Manufactured mechanical valve: Made up of carbon-coated plastic, the mechanical valve is the most durable type of valve that will usually last for your entire lifetime.
- Donors valve: This is an actual human valve taken from a donor and implanted in your heart . It usually lasts for anywhere between 10 to 20 years.
- Tissue valve: Created from animal valves or tissues, this type of heart valve is expected to stay healthy for 10 to 20 years after the surgery.
Your doctor will discuss the benefits and risks of the available surgical options as well as of the types of valves.
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Death Rate Rockets 10 Years After A Coronary Artery Bypass Why
Something happens 10 years after heart bypass surgery, when people suddenly face a dramatically increased risk of dying.
This surprising observation has emerged from a study of health registries that Denmark fastidiously keeps of all its citizens.
It shows people do very well for about eight to 10 years and then their risk of dying goes up by 60 to 80 per cent.
Following heart bypass surgery, people do well and then the death rate mysteriously goes up. supplied
Danish researchers believe this may be due to the fact that the disease is progressive and that the atherosclerosis or hardening of the arteries increases. It could also be that the implanted material begins to fail.
They stress this is important information for the doctors who monitor these patients, showing there is particularly good reason to assess each patient’s prognosis after the initial eight to 10 years.
Cardiac bypass surgery treats blocked coronary arteries which are the vessels that supply the heart with blood.
Rather than removing the blockages in the arteries, the surgery creates alternate pathways to allow blood to flow around the blockages and into the heart.
The operation is colloquially known as “cabbage”, from CABG, which stands for Coronary Artery Bypass Grafting.
After observing the information on long-term mortality after bypass surgery was sparse, the Danish researchers decided to analyse 30 years of data from the registries, beginning in 1980.
How Long Does Heart Bypass Surgery Last Dont Lose Sight Of The Main Issue
Remember that the bypass was done to treat coronary artery disease, but thats only half the battle. The same disease process still goes on despite the bypass and so the emphasis in these patients should be on treatments that can act to stabilize the heart disease. These treatments include medications, blood pressure control, cholesterol management, avoiding smoke, exercise, diet, and adoption of a healthy lifestyle. Now these are the truly life-saving measures.
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Hand Sanitizer And Antibacterial Soap
It is nearly impossible to wash your hands too much when you are recovering from surgery. Frequent use of hand sanitizer, as well as proper handwashing technique, can prevent infection.
Keeping your hands clean, and never touching your incision without first sanitizing or washing your hands, can prevent infection.
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Beyond 6 Weeks Of Recovery
If you had open heart surgery and the surgeon divided your sternum, it will be about 80% healed after six to eight weeks. By that time, youll generally be strong enough to get back to normal activities such as driving, Dr. Tong says. You can probably also return to work, unless your job is physically strenuous.
Most importantly, this is the time to start a cardiac rehabilitation program.
This is a monitored exercise program designed to increase your hearts endurance. Through cardiac rehabilitation, you can gradually increase your activities, and your doctors will watch your progress closely. Youll also learn more about how you can change your lifestyle and diet to keep your heart healthy.
Working through a cardiac rehabilitation program is the best way to find out when youre strong enough to resume the more strenuous activities you enjoy.
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What Is The Coronary Artery Bypass Graft Surgery Procedure
In general, the CABG procedure begins with general anesthesia and intubation followed by sawing through the breastbone.
- The heart is cooled with a preservative and then a cardiopulmonary bypass machine that takes over as a pump for the heart and also functions as a lung) is started .
- The bypass machine is placed so the aorta can be clamped off to allow bypass grafts to be attached to the aorta in a bloodless surgical field.
- Then bypass grafts are attached to a coronary artery beyond the blockage.
- The heart/lung machine is taken off and the heart takes over after rewarming as the pump that moves the blood.
- The breastbone is then wired back together.
- Other items like breathing tube and chest tubes are removed as the patient continues with recovery.
- Statistics suggest about 5% of new CABG patients need a redo or exploration due to bleeding after surgery.
Dialysis After Open Heart Surgery
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How Long Do Heart Patients Stay In Icu
Hospital stay associated with prolonged organ failure tended to last 20 days on average, and this was 25% quartile, 75% quartile. Intensive care unit stays averaged 2 .A total of 141 were recorded.In 3. 5% of these cases, patients stayed longer than 14 days in the ICU 57 of those died and 53 at some point.
Your Eating Habits May Change
You may notice that youve lost your appetite or you just feel too tired to eat. This is common, so be patient. Your appetite will soon be back to normal.
We suggest you try eating frequent, small meals throughout the day. You need proper nutrition to enable your body to heal and get stronger.
We recommend a diet low in fat, cholesterol and sodium and high in protein. Good sources of protein include fish, eggs, dairy, beans and nuts. Limit the amount of salt in your diet to 2,000 milligrams a day. Foods known to be high in salt include restaurant food, soups, pizza, bacon and other processed meats.
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What You Need To Know Before Scheduling Surgery
Here are a couple of key suggestions if your doctor says you need a heart reoperation:
- Choose an experienced surgeon. Find someone who has done many heart reoperations. This type of procedure is not as common as an initial heart surgery, so it may take you more time to find the best-qualified physician.
- Hospital experience matters, too. Choose a hospital that has a lot of experience with reoperations and has a team of physicians readily available to handle any other medical issues you have.
Patients who have high risk factors or who undergo second procedures do best at high-volume medical centers where the surgical and support teams have a lot of experience. Almost one-third of the heart surgery operations we do are repeat procedures.
If youre facing a heart reoperation, keep in mind that the safety and success of these surgeries continue to grow, particularly when an experienced surgeon does your surgery at a high-volume center. Take the time to choose your hospital and surgeon carefully for the best outcome.
Preparing For The Surgery
Preparation for open heart surgery starts the night before. A person should eat an evening meal as usual but must not consume any food or drink after midnight.
It is a good idea to wear loose, comfortable clothing to assist with restricted movement following surgery, but wear whatever is comfortable.
Be sure to have all personal medical information on hand. This might include a list of medications, recent illness, and insurance information.
It is normal to feel anxious before an anesthetic, and people should not hesitate to seek reassurance from the healthcare team.
The doctor may request that the person washes their upper body with antibacterial soap. A member of the healthcare team may need to shave the persons chest area before they can have the anesthetic.
The doctors may also need to run tests before surgery, such as monitoring the heart or taking blood samples. A doctor or nurse might place a line into a vein to enable the delivery of fluids.
After the medical team has completed the preliminary tasks, the anesthesiologist will administer general anesthesia.
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