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Ten-year experience with mitral valve replacement in the elderly
C K Nair1, W P Biddle, A Kaneshige
1Division of Cardiology, Creighton University School of Medicine, Omaha, NE 63131.
Insights
Elderly patients undergoing mitral valve replacement face higher risks. This study identified key predictors of mortality in this population, highlighting the need for careful management.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Cardiac Valve Repair
Background:
- Limited data exists on mitral valve replacement (MVR) outcomes in elderly patients.
- This study compares perioperative and long-term mortality in elderly vs. younger patients undergoing MVR.
Purpose of the Study:
- To identify predictors of perioperative and long-term mortality in elderly patients undergoing MVR.
- To compare outcomes of MVR in patients aged 70 years and older versus younger patients.
Main Methods:
- Retrospective analysis of 126 consecutive MVR patients, divided into elderly (>=70 years) and younger groups.
- Evaluation of clinical, ECG, hemodynamic, and angiographic variables.
- Multivariate analysis to determine predictors of mortality.
Main Results:
- Elderly patients more frequently received bioprostheses and had higher pulmonary artery systolic pressure, fascicular block, and cardiopulmonary bypass time.
- A trend towards higher perioperative mortality was observed in the elderly group (27% vs. 12%).
- Long-term cardiac and total mortality rates were significantly higher in elderly patients (42% and 54%) compared to younger patients (24% and 35%).
Conclusions:
- Elderly patients undergoing MVR exhibit distinct clinical characteristics and face significantly higher perioperative and long-term mortality risks.
- Predictors of mortality differ between elderly and younger MVR patients.
- Aortic calcification and prolonged bypass time are critical factors for elderly patient mortality.
Abstract:
Limited data are available on mitral valve replacement in the elderly patient. Therefore we report our 10-year experience including predictors of perioperative mortality and subsequent long-term cardiac mortality in elderly patients with mitral valve replacement compared to younger patients. Of the 126 consecutive patients with mitral valve replacement, 26 were older (77 +/- 4, group 1) and 100 were younger (62 +/- 9, group 2) than 70 years. Bioprostheses were used more frequently in patients in group 1 (65% vs 7%, p less than 0.0001). Of the 21 clinical, ECG, hemodynamic, and angiographic variables studied, patients in group 1 had higher pulmonary artery systolic pressure (57 +/- 15 vs 48 +/- 19, p less than 0.05), fascicular block on ECGs (70% vs 33%, p less than 0.005), and greater pump time on cardiopulmonary bypass (160 +/- 75 vs 120 +/- 50 minutes, p less than 0.025). A trend toward a higher perioperative mortality rate was also seen in group 1 (27% vs 12%, p = 0.058). Predictors of perioperative mortality by multivariate analysis were the presence of aortic calcification and prolonged pump time on cardiopulmonary bypass in group 1 and coronary artery disease, female sex, elevated mean pulmonary artery pressure, and postoperative complete atrioventricular block in group 2. During a mean 4-year follow-up period, cardiac mortality and total mortality rates were 42% and 54%, respectively, for group 1 compared to 24% and 35%, respectively, for group 2.(ABSTRACT TRUNCATED AT 250 WORDS)