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Mitral valve replacement in the elderly is associated with low mortality and similar survival to the general

V Dayan1, G Soca, L Cura

  • 1Division of Cardiac Surgery, Instituto Nacional de Cirugia Cardiaca. Motevideo, Uruguay - victor_dayan@hotmail.com.

The Journal of Cardiovascular Surgery
|March 21, 2014
PubMed

Insights

Mitral valve replacement surgery in elderly patients demonstrates improved outcomes, with reduced mortality and comparable survival rates to the general population, especially for females. This procedure is a viable option for older adults with mitral valve disease.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Increasing elderly population leads to higher incidence of mitral regurgitation.
  • Elderly patients often denied surgery due to perceived poor surgical outcomes.
  • Mitral valve replacement is the preferred procedure in this center.

Purpose of the Study:

  • To analyze early and late survival in elderly patients undergoing mitral valve surgery.
  • To evaluate the feasibility of mitral valve replacement in older adults.
  • To identify predictors of mortality and survival in this patient group.

Main Methods:

  • Retrospective analysis of 127 patients over 70 years old undergoing first-time isolated mitral valve replacement (2000-2012).
  • Comparison of observed survival with expected survival in the general Uruguayan population.
  • Multivariate analysis to determine predictors of operative mortality and survival.

Main Results:

  • Overall operative mortality was 9.4%, significantly lower after 2006 (1.8% vs. 15.3%).
  • Pre-2006 surgery, low hematocrit, and high creatinine predicted operative mortality.
  • 6-year survival was 70.2% for females (similar to expected) and 40.1% for males (lower than expected).
  • Earlier surgery and female sex were independent predictors of better survival.

Conclusions:

  • Mitral valve replacement is a feasible and effective option for elderly patients with mitral valve disease, particularly in centers lacking valve repair expertise.
  • Current surgical results show low operative mortality and favorable survival rates, especially in female patients.
  • This study challenges the misconception of poor surgical outcomes in elderly patients undergoing mitral valve replacement.

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