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(Circulation. 2005;112:I-443 – I-447.)
© 2005 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Aortic Valve Replacement and Concomitant Mitral Valve Regurgitation in the Elderly

Impact on Survival and Functional Outcome

Christopher J. Barreiro, MD; Nishant D. Patel, BA; Torin P. Fitton, MD; Jason A. Williams, MD; Pramod N. Bonde, MD, MS, FRCS; Vincent Chan, BS; Diane E. Alejo, BA; Vincent L. Gott, MD; William A. Baumgartner, MD

From the Division of Cardiac Surgery, The Johns Hopkins Medical Institution, Baltimore, Md.

Correspondence to Dr William A. Baumgartner, Division of Cardiac Surgery, The Johns Hopkins Medical Institution, 600 North Wolfe St, Blalock 618, Baltimore, MD 21287. E-mail wbaumgar{at}csurg.jhmi.jhu.edu

Background— The impact of mitral regurgitation (MR) on elderly patients (70 years) undergoing isolated aortic valve replacement (AVR) is not clearly defined. This study investigates the long-term effects of preoperative, moderate MR on survival and functional outcome in elderly AVR patients.

Methods and Results— A retrospective review identified 408 consecutive elderly patients who underwent isolated AVR from January 1983 to February 2004. The pathologic etiology of MR was determined on preoperative echocardiogram, and patients were stratified into no/mild MR (Group I; n =338) versus moderate MR (Group II; n =70). Follow-up was 95.1% complete. Functional outcome was evaluated using the Short Form-12 questionnaire. On univariate analysis, Groups I and II differed in incidence of previous myocardial infarction (13.9% versus 28.6%; P=0.004), hyperlipidemia (18.7% versus 33.3%; P=0.009), and congestive heart failure (50.0% versus 70.0%; P=0.002). On multivariate analysis, moderate MR was an independent risk factor impacting long-term survival (P=0.04). Actuarial survival at 1, 5, and 10 years for Group I was 93.8%, 73.3%, and 40.1% versus 92.3%, 58.2%, and 14.6% for Group II (P=0.04). Available postoperative echocardiograms for Group II (n =37) demonstrated improvement in MR in 81.8% of functional MR patients. However, MR persisted or worsened in 65.4% of patients with intrinsic mitral valve disease (myxomatous, calcific, or ischemic MR). Functional outcomes showed 77% of Group I versus 78.6% of Group II rated their health as good to excellent post-AVR.

Conclusions— Moderate MR is an independent risk factor impacting long-term survival in elderly patients undergoing AVR. Therefore, patients with intrinsic mitral valve disease should be considered for concomitant MV surgery.

Key Words: aging • valves • surgery • mitral valve • survival