The decision to go ahead and operate on 94-year-old Shrichand Chhabra was tough because of the many risks involved. “The oldest person I had operated on so far was 89, and that was in England. Chhabra had very low heart function, which made the risk of his surviving the surgery lower than other patients with heart disease,” says Dr ZS Meharwal, who did the open-heart surgery on the oldest person in India.
Damage to the heart and blood vessels because of existing coronary artery disease, hypertension (high blood pressure), cerebral vascular accident such as stroke, diabetes, calcified blood vessels, and peripheral vascular disease are some risk factors commonly present among elderly patients. With increasing longevity, however, many are ready to face the risks for a fitter and longer life.
High atherosclerosis (cholesterol and other fatty deposits), blood clots and calcification inside the blood vessels are the biggest problem because fragments of these can break loose during surgery and travel to the brain, causing stroke and other brain damage.
“This risk has decreased now because we do beating-heart surgery, which does not require a heart-lung machine to take over the function of the heart and lungs for the duration of the surgery," says Dr Meharwal.
The Annals of Thoracic Surgery reports that the heart-lung machine raises the risk of stroke and other brain damage in elderly patients.
The risk of secondary complications is higher in people over 75 years undergoing bypass surgery because along with the heart, all the organs — such as the lungs, kidneys, intestine and pancreas — function at a sub-optimal level, making recovery tougher and longer.
Chhabra was put on ventilator support for 48 hours after the January surgery, far more than the usual 12-20 hours needed for most bypass surgeries. His weakened heart was assisted with an intra-aortic balloon pump implant for five days, three of which were after surgery to support him though recovery.
As compared to the normal 7-8 days hospital stay, Chhabra had to stay in hospital for three weeks to ensure his body mended completely before he was discharged.
“All the body's tissues, including the heart and skin tissues, are weak in the elderly, which causes more bleeding in the heart during surgery, makes suturing tougher, and healing take more time,” says Dr Meharwal.
The decision to operate can be taken only after discussing the risks and benefits with the family. “The first question to answer is whether the quality of life of the patient will improve after surgery,” the doctor says.
“In this case, the patients' family said we should go ahead even if there was a 10 per cent chance of recovering because the alternative was being hospitalised indefinitely. We took the risk, and the result is there for you to see,” Dr Meharwal adds.