Prior to heart valve surgery, patients are faced with many, many, many questions. One of those questions is specific to potential blood loss during the operation. That question is, “Would you like to donate your own blood or use blood from the hospital blood bank?”

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I just received an email from Mel, an eighty year old patient that requires aortic valve replacement. Mel wrote to me, “Adam – I am 80 years old and will need an aortic valve replacement in the coming months. Do you have any experience with people in my age bracket who have had this replacement. What has been their experience?”

This is one of the more common questions I receive from elderly patients and caregivers of elderly patients needing heart valve repair or heart valve repair surgery. Recently, some interesting information has been published about this exact topic – valve surgery in those over eighty years old.

In one new study, it was found that age should not disqualify elderly patients from having heart valve surgery.

Dr. Farzan Filsoufi and colleagues from the Mount Sinai School of Medicine in New York City found that patients 80 years of age or older who underwent aortic valve replacement fared nearly as well as younger patients, according to Reuters Health.

With the aging of the population (e.g. the baby boomers), valve surgery is expected to become more common in the United States. In this new report, published in Journal of the American Geriatrics Society, researchers reviewed the records of 1,308 consecutive patients who underwent the procedure at Mount Sinai between 1998 and 2006. Of these patients, 17.6 percent were 80 or older. The report found that older patients were no more likely to die in the hospital than the younger patients.

There were some elements of the report that did uncover some challenges for the elderly patients following heart valve surgery.

• Elderly patients did have a greater risk of respiratory failure
• Elderly patients spent an average of 10 days while younger patients stay five days less.

The real good news of the report? About two thirds of the oldest patients lived for at least 5 years after the operation, a rate of survival comparable to people of the same age in the general population. Dr. Filsoufi believes that the advances in cardiac surgery technology is the key reason for the positive findings of the study. And, he believes that less invasive surgical techniques (percurtaneous, robotics) may enhance the elderly results further.

I hope that helps answer Mel’s question about heart valve surgery for the elderly.

Keep on tickin!

One of my favorite television shows is 60 Minutes on CBS. I love the stories. I love the reporters. And, I love the way they tackle subjects that really make you think. (I even find Andy Rooney pretty darn funny.)

Yesterday, however, I was watching a very troubling 60 Minutes story about Trasylol. As you may know, Trasylol is a drug used during cardiac bypass surgery (including heart valve repair and heart valve replacement) to prevent blood clotting. The drug is manufactured by Bayer and its generic name is Aprotinin.

In February, 2006 a study published in the Journal of the American Medical Association found patients on Trasylol during cardiac bypass surgery were at greater risk of dying over the next five years than those given two other medications. The same researchers also linked Trasylol to an increased risk of kidney failure, during the 60 Minutes clip.

As you would imagine, I continued to watch this 60 Minutes Trasylol piece with acute attention considering my aortic valve replacement surgery was in 2005.

“Our present findings deal with death,” one of the JAMA study’s authors, Dr. Dennis T. Mangano, stated. Mangano, director of the Ischemia Research and Education Foundation, a California-based nonprofit group, said that “the death rate for aprotinin patients far outstrips that for the other two drugs.”

His team’s study tracked the long-term survival of almost 3,900 heart patients who underwent coronary artery bypass surgery at 62 medical centers worldwide and found that the five-year death rate for patients given Trasylol was 20.8 percent, compared to 15.8 percent for those given another drug, aminocaproic acid, and 14.7 percent for those given tranexamic acid.

In total, researchers estimate the use of Trasylol resulted in the death of 22,000 patients during the fourteen years it was on the market.

The really gripping part of the story dealt with Bayer’s negligence and failure to publicly produce their own data (with the FDA) that supported Dr. Mangano’s research. In essence, Bayer continued to keep Trasylol on the market even though Bayer may have known the medication had an overwhelmingly negative side effect… Death.

That said, I found a portion of the 60 Minutes Trasylol story on the Internet. The story is called “One Thousand Lives A Month”.

Keep on tickin!

Earlier today, I was exchanging emails with Dr. Paul Stelzer of Mount Sinai about the efficacy of the Ross Procedure. As you may know I had a Ross Procedure (aortic and pulmonary valve replacement), a few years ago due to severe heart valve disease (aortic stenosis).

Dr. Paul Stelzer – Mount Sinai (New York)

In talking with Dr. Stelzer, I learned some very interesting information about Dr. Stelzer’s history with the Ross Procedure.

According to Dr. Stelzer, he has performed 475+ Ross Procedures as of today.

That’s mighty impressive!!!

I could be wrong but I think that qualifies him as one of the world’s leading surgeons for this form of heart valve replacement. FYI, Dr. Vaughn Starnes, my surgeon, has performed about 250 Ross Procedures.

That said, Dr. Stelzer informed me that he is looking to reconnect with some of his patients to better understand, detail and report his twenty year experience with this innovative approach to aortic and pulmonary valve replacements.

If you are a former patient of Dr. Stelzer and would like to chat with him, you can reach him at the following contact information:

Paul Stelzer, MD

Phone: 212+659-6871
Fax: 212+659-6818
e-mail: Paul.Stelzer@mountsinai.org

Department of Cardiothoracic Surgery
Mount Sinai Medical Center
1190 Fifth Avenue, Box 1028
New York, NY 10029

To learn more about Dr. Paul Stelzer, click here.

Keep on tickin!

I’m on day three of my work trip through Japan. So far, Tokyo is very impressive and… very crowded! I almost had a panic attack walking through the train stations this morning. So many people! I’ve since learned that Tokyo is one of the most populated cities in the world, with a population over 12 million.

Needless to say, the jet lag is still overwhelming considering I live in Los Angeles. That said, I’ve had some extra, early morning hours to dig through my inbox and answer some questions. I just received an interesting question about life expectancy after heart surgery. It reads, “Adam – Do you know what the life expectancy is for patients after heart valve surgery?”

That is a great question. Unfortunately, it is a very tough question to answer. As for life expectancy after heart valve surgery, it’s almost as difficult to answer, “How long will a mechanical mitral valve last?”

I say that because heart valve surgery is a relatively new area of medicine. Cardiac surgery, bypass operations, etc. have only really been around for thirty or forty years. For this reason, researchers are still developing their datasets as they track the lives of heart valve surgery patients.

However, there is some data about life expectancy after heart surgery that I just found at St. Jude Medicals One Valve For Life Website. According to their research, “the mean age of patients presenting for valve surgery is increasing, as is the life expectancy following valve surgery.”

The data collected thus far is very encouraging, as shown above. I say that because, as a double heart valve surgery patient, I want to live as long as humanly possible! I’m just about to complete year two following my aortic and pulmonary valve replacements.

So you know… Last week, I received a very nice email from a patient who had her valve replaced 34 years ago. Yep. You read that right. 34 years!!!

I hope this helps you better understand life expectancy after heart valve surgery.

Keep on tickin!