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Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short ‐ and Long ‐ Term Outcomes in a Propensity ‐ Matched Cohort

View Article: PubMed Central - PubMed

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.

No MeSH data available.


Study design. NYHA indicates New York Heart Association.
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jah31656-fig-0001: Study design. NYHA indicates New York Heart Association.

Mentions: We retrospectively explored our dedicated in‐hospital database for patients who underwent MV surgery between 1994 and 2015. Of 1776 patients treated, those aged <75 years, or who underwent concomitant aortic valve replacement, surgery of the aorta, repeat cardiac procedures, or suffered from active endocarditis were excluded. According to the treatment received, the remaining 341 patients were divided into a cohort of MV‐repair (n=221) and MVR (n=120) and were compared regarding all documented baseline variables. Variables with significant difference between the groups were included for propensity matching (threshold P=0.10). This yielded 126 patients after MV‐repair (n=63) and MVR (n=63). Both cohorts, unmatched and matched, were included in this study for further analyses (Figure 1).


Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short ‐ and Long ‐ Term Outcomes in a Propensity ‐ Matched Cohort
Study design. NYHA indicates New York Heart Association.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5015286&req=5

jah31656-fig-0001: Study design. NYHA indicates New York Heart Association.
Mentions: We retrospectively explored our dedicated in‐hospital database for patients who underwent MV surgery between 1994 and 2015. Of 1776 patients treated, those aged <75 years, or who underwent concomitant aortic valve replacement, surgery of the aorta, repeat cardiac procedures, or suffered from active endocarditis were excluded. According to the treatment received, the remaining 341 patients were divided into a cohort of MV‐repair (n=221) and MVR (n=120) and were compared regarding all documented baseline variables. Variables with significant difference between the groups were included for propensity matching (threshold P=0.10). This yielded 126 patients after MV‐repair (n=63) and MVR (n=63). Both cohorts, unmatched and matched, were included in this study for further analyses (Figure 1).

View Article: PubMed Central - PubMed

ABSTRACT

Background: Because of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV&#8208;repair) is the &ldquo;gold standard&rdquo; treatment for MV disease, in elderly patients, there is controversy about whether MV&#8208;repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20&nbsp;years.

Methods and results: Our in&#8208;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 &ge;75&nbsp;years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV&#8208;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&#8208;day mortality was 5.4% (MV&#8208;repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1&#8208; and 5&#8208;year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P&lt;0.01). Median survival after MV&#8208;repair was 7.8&nbsp;years, close to 8.5&nbsp;years (95% CI: 8.2&ndash;9.4) in the age&#8208;matched UK population (ratio 0.9). Rate of re&#8208;operation for MV&#8208;dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV&#8208;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&#8208;term survival is superior after MV&#8208;repair and the re&#8208;operation rate is low. MV&#8208;repair should be the preferred surgical approach in elderly patients.

No MeSH data available.