[HSF] Nonagenarians and Cardiac Surgery

[Nasser F. Abou'Seada]

in the part of the world where I do practice, it is mostly questionable to
offer a surgical procedure for someone who is in his 70s .... even the
family would question the advice for surgery ...... sometimes even for a
palliative procedure .... it seems that the "let pass in peace" has a deeply
rooted cultural bias in the society ... 

Still however .... I meant to support the concept on a mere logic grounds
... not a factual one .... meaning that I would not turn a patient down
simply for his age ..... may be for other significant factors /
co-morbidities at a lower age .... yet certainly not on the base of age as
an absolute number alone. 

NFA

> From: Salerno, Tomas
> Sometimes it is important to pause and ask questions, such as operations
in 90>
> year-old patients...
> Tomas


> From: Nasser F. Abou'Seada
> > Age is a number to be considered, but I
> > > feel obligated to evaluate the patient's cormorbidites, mental
> > > acuity, mental outlook, etc, before categorically denying a patient
> > > surgery just because they are in their 90's.<
> 
> Certainly Sounds Logic .... totally agree ........ though having no such
> patient in such age group ...
> 
> NFA


> > From: Edward Bender
> > I remember a 92 year old with disabling angina I did a CABG on a
> > couple of years ago.  Discharged on post-op day 4, and then he went
> > to Las Vegas to help set up an amusement park type train for a couple
> > of the casinos.  There are 90 year olds and then there are 90 year
> > olds.  Generalizations don't equate to universality.
> > Ed Bender, MD


> > On Nov 17, 2006, at 2:25 PM, hgrmd at aol.com wrote:
> >
> > > Tomas,
> > >   I've done several patients in their 90's in my career.  Most of
> > > them did reasonably and sometimes surprisingly well.  The key is
> > > selection.  I generally won't operate on your average patient in
> > > their 90's, but there are worthy exceptions.  Heck, I've turned
> > > down some patients in their 30's or 40's because the cormorbidities
> > > and the heart were so bad.  Age is a number to be considered, but I
> > > feel obligated to evaluate the patient's cormorbidites, mental
> > > acuity, mental outlook, etc, before categorically denying a patient
> > > surgery just because they are in their 90's.  An example was the
> > > sharp 93 yo grandmother of an internist who kept being admitted for
> > > chest pain from severe 3vd.  I did her CABG, she did well, and was
> > > living an active life at least 4 years later.  I'm sure plenty of
> > > other members of HSF can relate similar experiences.
> > > Hal
> > >
> > >
> > > -----Original Message-----
> > > From: TSalerno at med.miami.edu
> > > To: OpenHeart-L at lists.hsforum.com
> > > Sent: Fri, 17 Nov 2006 2:08 PM
> > > Subject: RE: [HSF] Factor VII
> > >
> > >
> > > Should a 90 year old be subjected to heart surgery? Anyone has seen
> > > his/her grandmother at that age, and what she looks like?
> > >
> > > Tomas
> > >
> > > -----Original Message-----
> > > From: openheart-l-bounces at lists.hsforum.com
> > > [mailto:openheart-l-bounces at lists.hsforum.com] On Behalf Of Ben
> > > Bidstrup
> > > Sent: Friday, November 17, 2006 1:49 PM
> > > To: OpenHeart-L at lists.hsforum.com
> > > Subject: Re: [HSF] Factor VII
> > >
> > >> Prasanna,
> > >>   Basically, I wasn't thinking of the possible legal consequences
> > >> when
> > > I
> > >> used VII, because I knew the potential for such was nil.  No South
> > > Florida
> > >> lawyer on contingency is going to take a case of a 90 yo cardiac
> > >> surgical patient
> > >> against a bare surgeon.  Now, if the patient had been in  her 50's
> > >> with
> > > a
> > >> difficult family, then I might have had other thoughts.
> > >> Hal
> > >> _______________________________________________
> > >
> > > Hal,
> > > I am sure very few of us in a situation like this think of anything
> > > but the benefits for the patient. It is easy to be 'wise' after the
> > > event and that is what we are able to do here.
> > >
> > > --
> > > Ben Bidstrup FRACS FRCSEd FEBCTS
> > > Consultant Cardiothoracic Surgeon