Elderly patients, mostly over 80 years of age, are always considered high risk for cardiac surgery.
Heart block, a condition that occurs when blood flow to the heart is reduced or blocked, is an extremely serious cardiovascular problem that requires serious and immediate intervention. According to doctors, it is important to clear out the blocked blood vessels and help them regain normal blood flow.
Therefore, coronary artery bypass surgery, or CABG, is the most common heart surgery in which coronary artery bypass is performed to increase blood supply in case of severe coronary artery disease. Although the procedure is well established, elderly patients, mostly those over 80 years of age, have been considered high risk for the disease. Statistics indicate that mortality rates of more than 8.1 percent are reported in octogenarians. However, with improved surgical techniques of late, doctors say that outcomes have improved considerably.
In recent years, there has been a fundamental change in the practice of the medical community in India itself when it comes to treating elderly patients with this problem. “It is more about age being an absolute indication rather than a detailed assessment of the patient’s overall health, lifestyle and support system. This has helped more elderly patients benefit from coronary artery bypass surgery and enjoy a better quality of life, even prolonging life expectancy in many cases,” Dr Manmohan Singh Chauhan, Consultant and Director, CTVS, Manipal Hospital, told Times Now.
What are the treatment problems in the elderly?
According to Dr Singh, careful planning and execution of surgery is necessary for elderly patients. “Co-morbid conditions such as diabetes, history of stroke and others that develop with age make surgery extremely complicated. The surgical team must weigh issues such as mental status, nutritional status and availability of a good support system at home before deciding on surgery,” he said.
CABG in elderly patients helps prevent sudden death due to cardiac causes, improves exercise tolerance, reduces angina, and decreases the need for future hospitalization.
Research indicates that postoperative complications are one of the most important risk factors for mortality in the elderly. “Therefore, it becomes very important to minimize such complications, in terms of careful surgical planning and postoperative care. Patients who do not have a history of congestive heart failure and have good renal and pulmonary function tend to do better after surgery,” Dr. Singh added.
How a 90-year-old patient was treated with CABG
A unique example of successful CABG surgery in an elderly patient is the case of Colonel Rajpal Singh, a 92-year-old retired Indian Army officer from Haryana. Despite his advanced age, considerations in the nonagenarian’s evaluation for CABG surgery were complex, including diabetes, history of previous stroke, seizure disorder, and prostate cancer.
Colonel Singh was suffering from recurrent acute chest pain for the last 5-6 months and his coronary angiogram revealed a highly calcified three-vessel coronary artery disease. While the doctors initially decided to perform angioplasty on him, since he had a known case of prostate cancer, it was decided that he should undergo coronary artery bypass surgery.
Colonel Singh successfully underwent triple bypass surgery, with grafts placed in all three main coronary arteries. “Despite the complexity and duration of the four-hour procedure, he recovered remarkably well. He was able to breathe on his own within hours, began taking food orally the same day, and started walking the next day,” Dr. Singh said. The patient’s heart function improved significantly, rising from 40 to 60 percent, and he was discharged on the sixth day after surgery.
Colonel Singh is currently recovering from surgery.
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