Affiliation:
1. Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK
Abstract
Background
Because of demographic changes, a growing number of elderly patients present with mitral valve (
MV
) disease. Although mitral valve repair (
MV
‐repair) is the “gold standard” treatment for
MV
disease, in elderly patients, there is controversy about whether
MV
‐repair is superior to mitral valve replacement. We reviewed results after
MV
surgery in elderly patients treated over the past 20 years.
Methods and Results
Our in‐hospital database was explored for patients who underwent
MV
surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with
MV
disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221
MV
‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (
MV
‐repair) versus 9.2% (mitral valve replacement,
P
=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (
P
<0.01). Median survival after
MV
‐repair was 7.8 years, close to 8.5 years (95%
CI
: 8.2–9.4) in the age‐matched
UK
population (ratio 0.9). Rate of re‐operation for
MV
‐dysfunction was 2.3% versus 2.5% (mitral valve replacement,
P
=1.0). After propensity matching, patients after
MV
‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%,
P
=0.03).
Conclusions
Excellent outcomes can be achieved after
MV
surgery in elderly patients. Long‐term survival is superior after
MV
‐repair and the re‐operation rate is low.
MV
‐repair should be the preferred surgical approach in elderly patients.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
41 articles.
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