Rethinking Mitral Valve Surgery during the Golden Years
The benefit of MV surgery in elderly patients remains a major area of controversy in the treatment of mitral regurgitation. The paper by Vassileva and colleagues in this issue of Circulation examines contemporary data from the Medicare to determine how older patients fare after undergoing isolated MV surgery. This issue has important health and economic implications given the high prevalence of hemodynamically significant mitral regurgitation over the age of 75. 1 Older studies have shown high mortality in elderly patients undergoing MV replacement in excess of 14%, and even greater than 20% in low volume centers. 2 However concomitant CABG is common in older patients, and prior MV surgery studies in the elderly contained a mix of patients often needing concomitant CABG or interventions on other valves. In addition, the studies included both MV repair and MV replacement patients, undoubtedly skewing the risk profile since mortality and adverse outcomes for MV replacement has consistently been shown to be higher most studies.3, 4, 5-7
- Received April 3, 2013.
- Accepted April 5, 2013.