Original article
Adult cardiac
Outcomes of Mitral Valve Repair Versus Replacement in the Elderly

https://doi.org/10.1016/j.athoracsur.2019.07.057Get rights and content

Background

This study evaluated outcomes of mitral valve surgery (MVS) in the elderly.

Methods

Patients 75 years or older undergoing MVS at a single center between 2010 and 2018 were included. Patients were stratified into mitral valve repair (MVr) or replacement (MVR). The primary outcome was mortality. Secondary outcomes included postoperative complications, readmissions, and freedom from at least moderate mitral regurgitation. Multivariable Cox regression was used for risk adjustment. A subanalysis of isolated, non-reoperative MVS for degenerative disease was also performed.

Results

Elderly patients (n = 472) underwent MVS, 301 (64%) with MVr and 171 (36%) with MVR. The majority of cases (68%) were performed for degenerative etiologic process. Survival was similar between MVr and MVR at 1 year (84% versus 86%; P = .40) and 5 years (64% versus 64%; P = .59). Postoperative complications were also comparable. Freedom from readmission was lower in the MVR cohort at 1 year (57% versus 68%; P = .02) and 5 years (33% versus 43%; P = .02). In isolated MVS for degenerative etiologic process, there was no difference in early or late mortality between MVr and MVR, although readmissions were lower with MVr. Overall, freedom from mitral valve reoperation was comparable, and the freedom from at least moderate regurgitation was 86% at 5 years in the MVr group.

Conclusions

This study indicates that the outcomes of elderly patients undergoing MVS are acceptable with approximately 64% survival at 5 years. Our data suggest that MVr in the elderly may not confer a survival advantage but can be performed with durable results.

Section snippets

Study Population

Data were extracted from all patients who underwent MVS at a single institution between January 2010 and January 2018. Patients were included if aged 75 years or older. Isolated MVS as well as MVS with concomitant coronary artery bypass grafting (CABG), tricuspid valve surgery, or arrhythmia surgery were included. MVS with concomitant aortic procedures, including aortic valve replacement, were excluded. All causes of mitral valve disease were included. Patients with preoperative cardiogenic

Baseline Characteristics

A total of 472 elderly patients (mean age, 80 ± 4 years) underwent MVS during the study period, including 301 patients (64%) with MVr and 171 patients (36%) with MVR. Patients undergoing MVR were higher risk as evidenced by a higher STS-PROM (12.0% ± 8.2% versus 6.9% ± 6.1%; P < .001) (Table 1). There were more women, higher body mass index, a higher proportion with prior open-heart surgery, and more patients with a history of arrhythmias, congestive heart failure, and prior mediastinal

Comment

Elderly patients are less frequently referred for MVS because of concerns of higher operative risk.7 In addition, factors such as compromised tissue integrity, increased annular calcium burden, and higher proportion of concomitant coronary artery disease can alter the selection of MVr versus MVR more commonly in the elderly. In an analysis of the national STS database, mitral repair rates were 62% in patients younger than 55 years of age and 45% in patients 80 years of age or older (P < .001).8

Cited by (9)

  • Current status of the treatment of degenerative mitral valve regurgitation

    2021, Revista Portuguesa de Cardiologia
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    Furthermore, there is overwhelming consistent and cumulative evidence worldwide that early surgery should be the preferred management for organic MR.22–27 There are various factors that make MVr the gold standard treatment for severe MR. Firstly, MVr confers superior outcomes to valve replacement and improves life expectancy.6,29–35 These demonstrated advantages of MVr include better short- and long-term survival,6 improved quality of life, better preservation of left ventricular function, and greater freedom from endocarditis and anticoagulant agent-related bleeding.5

  • Invited Commentary

    2020, Annals of Thoracic Surgery
  • Mitral Valve Repair Versus Replacement in The Elderly

    2023, Seminars in Thoracic and Cardiovascular Surgery
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    Our favourable long-term survival results for mitral valve surgery in the elderly might be explained by our definition for elderly defined as aged 70 years and older, which is lower than in the previously mentioned studies. Hospital mortality after mitral valve surgery in patients aged 70 years and older varies from 3-6% in recent studies,10,11 which is comparable to the results of our study. Few meta-analyses revealed higher early mortality in mitral valve replacement.21,22

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