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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.


Long‐term survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.
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jah31656-fig-0002: Long‐term survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.

Mentions: Exploration of the National Health Service central register facilitated 100% completeness of survival data. Median follow‐up was 5.3 years (1920 days) in the overall cohort, being 5.1 years in MV‐repair (1849 days) and 6.7 years in MVR (2443 days). Long‐term survival of the total cohort was superior after MV‐repair with Kaplan–Meier survival at 1, 2, and 5 years of 90.7%, 89.0%, and 74.2% versus 81.3%, 77.1%, and 61.0% (P<0.01). In patients with degenerative MV pathology, survival at 1 and 5 years was 95.0% and 81.8% (MV‐repair) versus 81.8% and 64.9% (MVR, P=0.02). This survival benefit was still seen after propensity matching with 1‐, 2‐, and 5‐year survival of 93.4%, 91.6%, and 76.9% versus 77.2%, 75.2%, and 58.7% (P=0.03). Cause of death was identified in 95.6% of deaths at 30 days (22/23) and 73.8% of deaths at 12 months (31/42). At 12 months, deaths were noncardiovascular in 5.0% in MV‐repair (1/20) and 9.1% in MVR (2/22, P=1.00). Comparison to the age‐ and sex‐matched population showed that patients who survived the first year after MV‐repair had similar life expectancy as the general UK population (Figure 2). The yearly mortality rate of 4.1% after the first year in the MV‐repair cohort corresponds to the natural yearly mortality of UK citizens aged 80 years of 4.9% in 2013 as reported by the European Commission and the office for National Statistics. Yearly mortality after MVR was 5.1%.16 Median life expectancy after MV‐repair was 7.8 years versus 8.5 years of age‐ and sex‐matched UK citizens (ratio: 0.9).


Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short ‐ and Long ‐ Term Outcomes in a Propensity ‐ Matched Cohort
Long‐term survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.
© Copyright Policy - creativeCommonsBy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5015286&req=5

jah31656-fig-0002: Long‐term survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.
Mentions: Exploration of the National Health Service central register facilitated 100% completeness of survival data. Median follow‐up was 5.3 years (1920 days) in the overall cohort, being 5.1 years in MV‐repair (1849 days) and 6.7 years in MVR (2443 days). Long‐term survival of the total cohort was superior after MV‐repair with Kaplan–Meier survival at 1, 2, and 5 years of 90.7%, 89.0%, and 74.2% versus 81.3%, 77.1%, and 61.0% (P<0.01). In patients with degenerative MV pathology, survival at 1 and 5 years was 95.0% and 81.8% (MV‐repair) versus 81.8% and 64.9% (MVR, P=0.02). This survival benefit was still seen after propensity matching with 1‐, 2‐, and 5‐year survival of 93.4%, 91.6%, and 76.9% versus 77.2%, 75.2%, and 58.7% (P=0.03). Cause of death was identified in 95.6% of deaths at 30 days (22/23) and 73.8% of deaths at 12 months (31/42). At 12 months, deaths were noncardiovascular in 5.0% in MV‐repair (1/20) and 9.1% in MVR (2/22, P=1.00). Comparison to the age‐ and sex‐matched population showed that patients who survived the first year after MV‐repair had similar life expectancy as the general UK population (Figure 2). The yearly mortality rate of 4.1% after the first year in the MV‐repair cohort corresponds to the natural yearly mortality of UK citizens aged 80 years of 4.9% in 2013 as reported by the European Commission and the office for National Statistics. Yearly mortality after MVR was 5.1%.16 Median life expectancy after MV‐repair was 7.8 years versus 8.5 years of age‐ and sex‐matched UK citizens (ratio: 0.9).

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.