Routine Surgery, or Just for First Ladies?
Robert Latkany, MDMarch 06, 2009
The former First Lady, 83 year old Barbara Bush, had open heart surgery to repair her aortic valve on March 4, 2009. 
Comedian Robin Williams is scheduled to have a similar operation in March, 2009. Bush’s surgeon, Dr Gerald Lawrie, described the procedure as “routine”. It is hard to imagine that anything involving cutting through one’s chest wall and slicing open one’s beating heart could be routine, especially for an elderly patient like Barbara Bush. Why, a poor unsuspecting patient might think from such a description that the chance of a bad outcome such as death is as low as the chance of winning a lottery ticket. Not so.
Villemot et al found that 7.2% of patients who had aortic valve replacement with a mechanical prosthesis died within 30 days. Those over age 80 had a 9% risk of death within 30 days. Mistiaen et al determined that patients over age 80, those who needed urgent surgery, those with a history of a heart attack, and those who needed the cardiac medicine digitalis, were at greatest risk of death. Chukwuemeka et al defends aortic valve replacement surgery in over 80 year olds, having found an insignificant difference in his sample in short term death rates in those over 80 years of age (4.6%) versus those under the age of 80 (2.9%). Is it worth the risk to have this surgery? It depends on how hard it is to live with a dysfunctional aortic valve, and how likely one is to die without the surgery. Otten et al report a one year survival rate of 85% for patients who underwent percutaneous aortic valve replacement, 62% for patients who underwent traditional aortic valve replacement, and 40% for patients who refused surgery altogether. Let’s hope that Barbara Bush is one of the lucky ones.
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