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Cardiovascular Report - Pushing the Boundaries of Cardiac Surgery for Seniors

Cardiovascular Report Fall 2010

Pushing the Boundaries of Cardiac Surgery for Seniors

Date: September 17, 2010

Back in action, Fisher Howe says the only thing that stops him from playing tennis again is a recently acquired condition he calls FOF, “fear of falling.”
Back in action, Fisher Howe says the only thing that stops him from playing tennis again is a recently acquired condition he calls FOF, “fear of falling.”

When Duke Cameron sized up the cardiac patient who stood before him in the early spring of 2009, he held his skepticism in check. The man was 94. “But my goal,” the man said, “is to make it to 100.”

Cameron, the chief of cardiac surgery at Johns Hopkins, knew some basic things in advance of his new patient’s visit. The patient had survived a multivessel coronary artery bypass in 1988. When the bypasses began to give out in 2008—a common occurrence 20 years after surgery—he was hospitalized twice, emerging with two new stents aimed at restoring lost blood flow.

But the patient still couldn’t walk across the room without gasping for breath. Physicians near his home said they were running out of options. At 94, they believed, he was clearly not a surgical candidate.

Most patients in such a circumstance might have packed it in. But most patients are not Fisher Howe.

You could make the case that Howe had already lived nine lives, and then some. He was a career diplomat. He’d graduated from Harvard, served in naval intelligence during World War II, kept ascending the ranks in the State Department to a position as deputy head of intelligence, later becoming the deputy chief of mission to both Norway and Holland. He followed that up with a turn as an assistant dean at Johns Hopkins’ School of Advanced International Studies and finally “retired” as a management consultant for nonprofit organizations, authoring four books with his gathered wisdom.

In his spare time, Howe took up tennis. And not just any old tennis. Into his 90s, he’d placed third in his U.S. age group.
So when Cameron assessed this particular patient’s dangerously narrowed aortic valve and considered surgery, he also took in the remarkable character traits of an individual with an uncommon zeal for life. He respectfully disagreed with the physicians who had encouraged Howe to settle for a shorter lifespan, telling Howe, “I think you’ve got the stuff to get through an operation.”

The obvious surgical risks were at least enough to give Howe pause: up to a 4 percent risk of death and up to a 10 percent risk of stroke. And, added Cameron, at the very least Howe would be in for a long and arduous recovery.

Despite the well-intentioned skepticism of family and friends, Howe made the leap. “I really wanted to hit that 100 mark,” he says. “My valve would deteriorate if I didn’t do something.”

During the operation, Cameron replaced Howe’s heavily calcified aortic valve with an animal valve and re-bypassed a badly narrowed coronary vessel. Howe needed a balloon pump to sustain him after the procedure and required extra time on the respirator. Afterwards, he spent 13 days in acute care, 10 days on a rehab floor and a month in a rehab facility near his Washington, D.C., home.

To Howe, it was worth it. He feels good again. He exercises daily on the rowing machine, the treadmill, the elliptical unit.

Cameron says Howe’s case is a way-shower. As the population ages, he says, cardiologists are seeing more patients with age-related aortic stenosis. And increasingly, many who are rejected for surgery because of age are reconsidered at Hopkins.

“We’ve seen three 90-plus patients in the past year who were turned down elsewhere,” Cameron says. “All three had great surgical results here.”

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