Published online before print July 17, 2006, doi: 10.1161/CIRCULATIONAHA.106.619239
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;114:265-272.)
© 2006 American Heart Association, Inc.
Cardiovascular Surgery |
Surgical Correction of Mitral Regurgitation in the Elderly
Outcomes and Recent Improvements
From the Division of Cardiovascular Diseases and Internal Medicine (D.D., V.T.N., A.J.T., M.E.S.), Division of Cardiovascular Surgery (T.M.S., H.V.S.), and Section of Biostatistics (C.G.S.), Mayo Clinic, Rochester, Minn.
Correspondence to Maurice Enriquez-Sarano, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail sarano.maurice{at}mayo.edu
Received February 7, 2006; revision received May 11, 2006; accepted May 31, 2006.
Background— In the elderly, mitral regurgitation (MR) is frequent, but surgery risks are considered high. Benefits and indications of MR surgery are uncertain in the elderly.
Methods and Results— Baseline characteristics, outcome, and trends for surgical results improvement were analyzed in elderly patients (
75 years of age; n=284) operated on for MR in 1980 to 1995 compared with younger patients (65 to 74 years of age, n=504; and <65 years of age, n=556). Preoperatively, class III to IV symptoms, atrial fibrillation, coronary disease, creatinine, and comorbidity index were more severe in elderly patients (all P<0.002). In the long term after surgery, observed survival stratified by age (75, 65 to 74, <65 years) was lower in elderly than in younger patients (at 5 years, 57±3%, 73±2%, and 85±2%, respectively; P<0.001), but ratios of observed to expected survival were similar (83%, 85%, and 88%, respectively). In multivariate analysis adjusted to expected survival, elderly patients showed no difference in life expectancy restoration compared with younger patients (adjusted hazard ratio, 0.89; 95% confidence interval, 0.73 to 1.30; P=0.54). Temporal trends showed that risk of operative mortality, although higher in elderly patients (P<0.001), declined markedly for all ages (27% to 5% in those 75 years of age, P<0.01; 21% to 4% in those 65 to 74 years of age, P<0.01; and 7% to 2% in those <65 years of age, P=0.06), with a parallel decline in low cardiac output and length of hospital stay. Over time, valve repair feasibility increased in all age groups (30% to 84% overall and 31% to 93% in degenerative MR; P<0.0001).
Conclusions— Elderly patients undergoing MR surgery display more severe preoperative characteristics and incur higher operative risks than younger patients. However, restoration of life expectancy after surgery is similar in elderly and younger patients, and outstanding recent surgical improvements particularly benefited elderly patients. Thus, elderly patients with MR can now carefully be considered for surgery before refractory heart failure is present.
CLINICAL PERSPECTIVE
Related Article:
-
Issue Highlights
Circulation 2006 114: 257.[Extract] [Full Text]
This article has been cited by other articles:
 |
|
 |
|
  C. K.N. Wan, J. A. Dearani, T. M. Sundt III, S. R. Ommen, and H. V. Schaff What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann. Thorac. Surg., September 1, 2009; 88(3): 727 - 731. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Maisano, G. Vigano, C. Calabrese, M. Taramasso, P. Denti, A. Blasio, A. Guidotti, and O. Alfieri Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 261 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D.-H. Kang, J. H. Kim, J. H. Rim, M.-J. Kim, S.-C. Yun, J.-M. Song, H. Song, K.-J. Choi, J.-K. Song, and J.-W. Lee Comparison of Early Surgery Versus Conventional Treatment in Asymptomatic Severe Mitral Regurgitation Circulation, February 17, 2009; 119(6): 797 - 804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. H. Gaasch and T. E. Meyer Left Ventricular Response to Mitral Regurgitation: Implications for Management Circulation, November 25, 2008; 118(22): 2298 - 2303. [Full Text] [PDF]
|
|
|
|
|
|
D. Detaint, B. Iung, L. Lepage, D. Messika-Zeitoun, G. Baron, P. Tornos, C. Gohlke-Barwolf, and A. Vahanian Management of asymptomatic patients with severe non-ischaemic mitral regurgitation. Are practices consistent with guidelines? Eur. J. Cardiothorac. Surg., November 1, 2008; 34(5): 937 - 942. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Russo, R. M. Suri, F. Grigioni, V. L. Roger, J. K. Oh, D. W. Mahoney, H. V. Schaff, and M. Enriquez-Sarano Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture Circulation, October 7, 2008; 118(15): 1528 - 1534. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. A. Carabello The Current Therapy for Mitral Regurgitation J. Am. Coll. Cardiol., July 29, 2008; 52(5): 319 - 326. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. H. Rahimtoola The Year in Valvular Heart Disease. J. Am. Coll. Cardiol., February 19, 2008; 51(7): 760 - 770. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Law and K.-L. Chan Surgical referral in symptomatic mitral regurgitation: greater compliance with guidelines is needed Eur. Heart J., June 1, 2007; 28(11): 1281 - 1282. [Full Text] [PDF]
|
|
|
|
 |
|
 Should Elders with MR Undergo Surgery? Journal Watch Cardiology, August 30, 2006; 2006(830): 5 - 5. [Full Text]
|
|
|
|
|
|
M. G. St. John Sutton and R. C. Gorman Surgery for Asymptomatic Severe Mitral Regurgitation in the Elderly: Early Surgery or Wait and Watch? Circulation, July 25, 2006; 114(4): 258 - 260. [Full Text] [PDF]
|
|