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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.


Event‐free 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-0003: Event‐free survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.

Mentions: As a result, Kaplan–Meier comparison of event‐free survival was significantly different in the unmatched cohort (P=0.05) but not significantly different between the propensity‐matched cohorts (P=0.20, Figure 3).


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

License
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getmorefigures.php?uid=PMC5015286&req=5

jah31656-fig-0003: Event‐free survival after MV‐repair and MVR in the overall and propensity‐matched cohorts. MV indicates mitral valve; MVR, mitral valve replacement.
Mentions: As a result, Kaplan–Meier comparison of event‐free survival was significantly different in the unmatched cohort (P=0.05) but not significantly different between the propensity‐matched cohorts (P=0.20, Figure 3).

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.