Original articleAdult cardiacOutcomes of Mitral Valve Repair Versus Replacement in the Elderly
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
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Cited by (9)
Current status of the treatment of degenerative mitral valve regurgitation
2021, Revista Portuguesa de CardiologiaCitation Excerpt :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
Mitral Valve Repair in the Elderly: Is It the Ideal Choice?
2020, Annals of Thoracic SurgeryInvited Commentary
2020, Annals of Thoracic SurgeryMitral Valve Repair Versus Replacement in The Elderly
2023, Seminars in Thoracic and Cardiovascular SurgeryCitation Excerpt :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
Elderly patients benefit from minimally invasive mitral valve surgery: Perioperative risk management matters
2024, Interdisciplinary cardiovascular and thoracic surgeryEarly mortality and neurologic outcomes following mitral valve surgery in the very elderly
2022, Journal of Cardiac Surgery