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Is mitral valve surgery safe in octogenarians?
Jayan Nagendran1, Colleen Norris, Andrew Maitland
1University of Alberta Hospital, Edmonton, Alta., Canada. jnagendr@ualberta.ca
Summary
Octogenarians undergoing mitral valve surgery face higher risks but show improved survival compared to the general elderly population, especially with valve repair. This highlights potential benefits for carefully selected elderly patients.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Cardiac Valve Disease
Background:
- Mitral valve surgery outcomes in octogenarians (patients aged 80 years and older) are not well-defined.
- Elderly patients often present with complex comorbidities, increasing surgical risk.
Purpose of the Study:
- To evaluate the outcomes and survival rates of octogenarians undergoing mitral valve surgery.
- To identify predictors of mortality in this patient cohort.
Main Methods:
- Prospective data collection from 1996-2004 at two surgical centers.
- Analysis of 58 octogenarian patients compared to younger patients undergoing mitral valve surgery.
- Survival analysis using Cox proportional hazards modeling and Kaplan-Meier statistics.
Main Results:
- Octogenarians had higher rates of cerebrovascular disease, urgent surgery, and combined mitral valve plus revascularization surgery.
- Thirty-day mortality was higher in octogenarians (15.5%) compared to younger patients (5.6%).
- Independent predictors of mortality included emergency surgery, combined revascularization surgery, mitral valve replacement, and advanced age.
Conclusions:
- Octogenarians undergoing mitral valve surgery experience increased risks but demonstrate a 7-year survival rate of 52.3%, exceeding community survival.
- Mitral valve repair offered greater survival benefit than replacement in octogenarians.
- Further research is needed to identify specific subgroups of octogenarians who may benefit most from this surgery.