Abstract 14186: Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Short and Long-term Outcomes From the Past Two Decades
Background: Due to demographic changes a growing number of elderly patients present with mitral valve (MV) disease. Mitral Valve Repair (MV-repair) is the gold-standard treatment option for patients with MV disease. Nevertheless, in elderly patients there is still controversy if MV-repair improves outcomes of patients compared to mitral valve replacement (MVR).
We reviewed results after MV surgery in elderly patients treated at our institution over the past 20 years.
Methods: Our in-hospital database was explored for patients who underwent MV surgery between 1994 and 2015. A comparative survival-analysis was performed for MV-repair vs. MVR patients. Cox-regression was applied to adjust for age, valve pathology, ejection fraction (EF) and combined procedures.
Results: Of the 1776 patients identified, 356 (20.0%) were aged ≥75 years and received either MV-repair (n=224, 62.9%) or MVR (n=132, 37.1%). Patients with repeat cardiac surgery, endocarditis and concomitant aortic valve replacement were excluded. In 55.8% of MV-repair and 46.2% of MVR procedures were combined (p=0.10). Mean age was 79.3±3.1yrs (MV-repair) vs 78.4±2.9yrs (MVR: p=0.02). Logistic EuroSCORE was 14.8±1.3% (MV-repair) vs. 15.3±16.1% (MVR: p=0.77).
Median survival of all patients was 7.4years (95%CI: 6.8-8.1) compared to a survival of 8.5years (95%CI: 8.2-9.4) in the age matched UK population (Ratio 0.87; p=0.01). Thirty-day mortality was 6.3% (MV-repair) vs. 10.6% (MVR, p=0.16). Length of ICU-stay was 1.1±1.6 days vs. 1.0±1.0days (p=0.43). Overall 1-, 2-, 5- and 8-year survival after MV-repair (90.7%, 89.0%, 77.0% and 45.9% vs. 79.5%, 76.5%, 58.9% and 41.4%, p[logrank]=0.02) as well as adjusted survival at 1-, 2-, 5- and 8-years were significantly improved after MV-repair (91.1%, 90.2%, 81.0% and 52.5% vs. 77.7%, 76.1%, 56.2%, 37.0%, p<0.01). After MV-repair, impaired EF was an independent predictor of adverse outcome (p<0.01).
Conclusion: Mitral valve surgery is a reliable treatment option with excellent long-term outcomes in elderly patients. Long-term outcomes can be improved in this patient group if mitral valves are repaired.
Author Disclosures: M. Silaschi: None. S. Chaubey: None. M.M. Uzzamann: None. H. Khan: None. M. Singh: None. R. Deshpande: None. M. Baghai: None. O. Wendler: None.
- © 2015 by American Heart Association, Inc.