The valves in the heart that keep blood flowing in the right direction may become defective, requiring one or more of them to need repair or replacement. Heart valve replacements can be done via open heart surgery or using a minimally invasive technique. Either surgery is generally effective, but the minimally invasive surgery may be safer for some older patients. Still, all surgeries carry risk, and as people get older, the risk level rises.
General Surgical Risks
Heart valve replacement surgery carries some of the same risks that all surgeries carry, such as infections. These may occur at the incision site, or in the lungs, kidneys or even the new heart valves. Blood clots, usually in the legs, are also common. These are especially dangerous if they travel to the lungs. Excess bleeding is also a risk for many types of surgery. Some people have a negative reaction to anesthesia medications or have trouble breathing after anesthesia. One benefit of the minimally invasive surgery for older people is that patients aren't anesthetized for as long.
Age
One of the dangers of heart replacement surgery for seniors is just their age, according to a 2003 article in the "Journal of the American College of Cardiology." Being older and having cardiac issues increases the risk of death or other serious complications during or after heart surgery. Most research on heart valve repair or replacement, the article goes on to say, hasn't included people over 75 years of age, so doctors don't have as much evidence to guide them in their decision-making. Research reported in a 2010 issue of the journal "Cardiology," however, indicates that one widely used surgical risk score, called STS, is a fairly good indicator of the ability of an elderly patient to survive aortic valve replacement surgery.
Risks of Heart Valve Surgery
Besides having more medical issues prior to surgery, which makes surgery riskier, older people are also more susceptible to acute illnesses following heart valve replacement, including kidney failure, heart attack, stroke and post-pericardiotomy syndrome. Post-pericardiotomy syndrome occurs when the surgery causes the tissues around the heart to become inflamed. People who have this feel tired and may have a low-grade fever for several months following their surgery.
Replacing the Replacement
Replacement heart valves can be made of biologic material, usually derived from pigs, or be made of certain types of metal. Each has its advantages and disadvantages, one of which is how long they last. Metal valves rarely have to be replaced, but the biologic, or porcine, valves only last 10 to 15 years, so they do need to be replaced. These second replacements are often even more risky for seniors than the original replacement, especially if they are very elderly.
References
- Agency for Healthcare Research and Quality: Risks, Benefits of Emerging Heart Valve Replacement Technique Not Fully Understood
- "Journal of the American College of Cardiology": Valve surgery in the elderly
- "Cardiology": Evaluation of Operative Risk in Elderly Patients Undergoing Aortic Valve Replacement: The Predictive Value of Operative Risk Scores
- MedlinePlus: Heart Valve Surgery
- Science Daily: Elderly Patients in Need of Heart Valve Replacements Have Alternative to Surgery
