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[Mitral valve surgery in elderly patients]
1Serviço de Cirurgia Cardiotorácica, Hospitais da Universidade de Coimbra. antunes.cct.huc@mail.telepac.pt
Insights
Elderly patients with mitral valve disease can safely undergo surgery. Mitral valvuloplasty is often preferred over prosthetic replacement, offering durable results with acceptable risks in this population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Valvular Heart Disease
Context:
- Increasing life expectancy leads to a growing number of elderly patients with mitral valve pathology.
- Surgical indications are similar to younger patients, but increased mortality and morbidity necessitate careful patient selection.
- Optimizing patient condition pre-operatively can significantly reduce surgical risks.
Purpose:
- To evaluate the feasibility and outcomes of mitral valve surgery in patients over 70 years of age.
- To compare the risk-benefit ratio of mitral valvuloplasty versus prosthetic valve replacement in the elderly.
- To determine the safety and efficacy of mitral valvuloplasty for myxomatous mitral regurgitation in geriatric patients.
Summary:
- Mitral valve surgery was performed on 433 patients over 70 years old (11.6% of total) in Coimbra over 10 years.
- Mitral valvuloplasty was successful in over 90% of cases, with an overall mortality rate of 2.6%.
- Myxomatous mitral regurgitation, prevalent in this age group, showed the most durable results with valvuloplasty.
Impact:
- Mitral valve surgery is a viable option for elderly patients, offering acceptable mortality and morbidity rates.
- Pre-operative optimization is crucial for successful surgical outcomes in geriatric patients.
- Mitral valvuloplasty demonstrates superior long-term durability for myxomatous mitral regurgitation in the elderly, making it a preferred option.
Abstract:
The increase in life expectancy results in a larger number of elderly patients with mitral valve pathology requiring surgical correction. Generally speaking, the indications for surgery are identical to those which apply to other age groups, but the greater incidence of mortality and, especially, of morbility make a degree of selectivity advisable. More than with any group, it is important to consider the risk: benefit ratio. However, in the majority of cases, it is possible to optimise the clinical condition of the patients with a significant decrease in risk. One of the most controversial aspects is that of the advantages or disadvantages of mitral valvuloplasty vs. prosthetic replacement. Although the eventual lower durability of the valvuloplasty might be considered a contraindication, because of the risk of reintervention at a later age, I believe that valvuloplasty is also preferable in elderly patients. This is confirmed by the well known fact that mitral valvuloplasty for myxomatous mitral regurgitation, prevailing in this age group, has the most durable results among all types of pathology. In the last 10 years, 433 patients above 70 years of age (11.6% of the total) were subjected to valvular surgery in Coimbra. Valvuloplasty was possible in more than 90% of the cases of mitral valve surgery. The mortality was only 2.6%, but significantly higher than that observed in younger patients (0.8%). In conclusion, mitral valve surgery in elderly patients is feasible with acceptable mortality and morbidity, but pre-operative optimization of the patients is essential.