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(Circulation. 2003;108:298.)
© 2003 American Heart Association, Inc.

Clinical Investigation and Reports

Outcomes and Long-Term Survival for Patients Undergoing Mitral Valve Repair Versus Replacement

Effect of Age and Concomitant Coronary Artery Bypass Grafting

Vinod H. Thourani, MD; William S. Weintraub, MD; Robert A. Guyton, MD; Ellis L. Jones, MD; Willis H. Williams, MD; Sharif Elkabbani, MD; Joseph M. Craver, MD

From the Joseph B. Whitehead Department of Surgery, Division of Cardiothoracic Surgery, Carlyle Fraser Heart Center (V.H.T., R.A.G., E.L.J., W.H.W., J.M.C.), The Emory Center for Outcomes Research (ECOR) (W.S.W., W.H.W., S.E.), and the Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.

Correspondence to William Weintraub, MD, 1256 Briarcliff Rd, Suite 1N, Atlanta, GA 30306. E-mail wweintr{at}emory.edu

Original received February 5, 2002; de novo received May 29, 2002; revision received April 24, 2003; accepted April 27, 2003.

Background— A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement.

Methods and Results— A matched study was performed using prospectively collected data from the Emory cardiovascular database from 1984 to 1997 comparing 625 MV repair patients with 625 MV replacement patients. Mean age was significantly higher in the replacement group (56±14 versus 55±14 years). Preoperative demographics and postoperative outcomes were similar between groups. Length of stay (LOS) was significantly less in the repair group (9.5±9.4 versus 12.3±13.1 days). In-hospital mortality was significantly less in the repair group (4.3% versus 6.9%), and overall 10-year survival was significantly higher in the repair group (62% versus 46%). Ten-year survival of patients <60 years of age was significantly higher in repair patients (81% versus 55%) but similar in patients 60 years of age (33% versus 36%, respectively). Ten-year survival of MV repair without CABG was significantly higher compared with MV replacement patients (74% versus 51%) but similar to patients with concomitant CABG (28% versus 34%, respectively). Independent predictors of long-term mortality included increasing age, urgent/emergent status, female sex, diabetes mellitus, increasing weight, heart failure, decreasing ejection fraction, concomitant CABG, and MV replacement.

Conclusions— Mitral valve repair has reduced LOS and improved in-hospital and 10-year survival. However, in the present series, MV repair does not provide significant long-term survival benefit over MV replacement in patients older than 60 years of age or those requiring concomitant CABG.

Key Words: mitral valve • surgery • coronary disease • bypass

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