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Heart Advances for Very Elderly

Henry Kissenger

Henry Kissinger’s heart valve replacement surgery at age 91 in 2014 illustrated surgical advances that allow cardiologists to perform heart procedures in the frail and very elderly – operations that would have been deemed too risky just a few years ago.

“Somebody like Mr. Kissinger, a man in his 90s, would have been told they needed to suffer with their symptoms,” says cardiologist Chauncey Crandall, M.D., author of the #1 Amazon bestseller The Simple Heart Cure. “That’s no longer the case. We can fix their hearts.”

Kissinger – a former U.S. Secretary of State and Nobel Peace Prize winner – underwent the procedure Tuesday at New York – Presbyterian Hospital. He is said to be resting comfortably, but few other details have been released. Kissinger has a history of heart trouble, undergoing a triple coronary bypass in 1982 and an angioplasty in 2005.

A German-born Jewish refugee, Kissinger served as Secretary of State under Presidents Richard Nixon and Gerald Ford.

Most aortic valve replacements are performed because of aortic stenosis, a cardiac condition that affects an estimated 1.5 million Americans, mostly over the age of 65.

The aorta is the main artery that carries blood from the heart to the rest of the body. The aortic valve is one of the heart’s four cardiac valves. In the elderly it can become stiffened due to calcium deposits and no longer able to work properly. The result is aortic stenosis.

Aortic valve replacement is considered when the condition grows bad enough to cause symptoms, which include shortness of breath, congestive heart failure, and the heartbeat irregularity known as atrial fibrillation.

Traditional surgery requires an open-heart procedure during which the faulty valve is replaced with a biologic (pig) valve or a mechanical valve.

It is estimated that 20-30 percent of elderly patients who need a heart valve are too frail to undergo an open-heart operation. In the past, little could be done for them other than to try to manage their symptoms with drugs.

However, a new procedure known as transcatheter aortic valve replacement (TAVI or TAVR) changed that.

During TAVR, physicians use a catheter (a thin, flexible tube), through an incision in the groin or side of the chest to guide an artificial valve to the heart. Once in position, the new aortic valve opens and begins to work.

Kissinger’s advanced age and the fact that he has already undergone open-heart surgery likely makes him a good candidate for the TAVR procedure, said Harvey Kramer, M.D., senior physician and director of cardiovascular disease prevention at Danbury (Conn.) Hospital.

Dr. Kramer noted that Kissinger’s previous open-heart operation makes it more likely that his doctor would have wanted to use the catheter procedure to avoid opening his chest a second time. “There’s a lot of scar tissue that the surgeon has to work around,” said Dr. Kramer.

TAVR has a big advantage over open-heart surgery in recovery time. “We have lots of these very older patients who undergo the traditional surgery and they don’t fly out of the hospital very fast. They really take a hit,” said Dr. Crandall.

On the other hand, TAVR carries increased stroke risk and is approved only for patients too frail to have open-heart surgery.

In May, former astronaut and U.S. Senator John Glenn, who turns 93 this week, underwent TAVR and is reportedly doing well.

“The take home message is that more people in their 90s, the ones we used to call the ‘old old’ are now undergoing these procedures and are doing very well,” said Dr. Kramer.

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