Long Term Survival of Patients Undergoing Mitral Valve Repair and Replacement: A Longitudinal Analysis of Medicare Fee-for-Service Beneficiaries
Background—Despite the established superiority of mitral repair over replacement, its adoption in the treatment of elderly patients has not been uniform, partly due to lack of robust long term survival data. We present the long term survival of Medicare fee-for-service beneficiaries undergoing mitral valve repair and replacement over a ten year period.
Methods and Results—We used the Medicare database to identify 47,279 fee-for-service beneficiaries age ≥ 65 undergoing primary isolated mitral valve repair or replacement from 2000-2009. Operative mortality and long term survival are presented for repair and replacement. Operative mortality was 3.9% for patients undergoing repair and 8.9% for patients undergoing replacement. One, 5 and 10 year Kaplan-Meier survival estimates for patients undergoing repair were 90.9%, 77.1%, and 53.6%. One, 5 and 10 year Kaplan-Meier survival estimates for patients undergoing replacement were 82.6%, 64.7%, and 37.2%. Important predictors of mitral repair included younger age [OR 1.10, 95%CI 1.05-1.14], elective admission status [OR 1.34, 95%CI 1.27-1.41] and annual mitral procedure volume greater than 40 [OR 1.57, 95%CI 1.36-1.81. Female gender and the presence of comorbidities were associated with lower likelihood of repair.
Conclusions—Mitral valve surgery in the Medicare population carries less risk than previously reported. Given the favorable outcomes of elderly patients undergoing mitral valve surgery, and especially mitral valve repair, an approach of earlier identification and surgical referral appears justified regardless of age.
- Received February 26, 2013.
- Accepted March 12, 2013.