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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 27, 2014
PubMed

Insights

Mitral valve replacement surgery is a viable option for elderly patients, offering improved survival rates, especially for females, challenging previous perceptions of high surgical risk. This study highlights the feasibility and positive outcomes of the procedure in older adults.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

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

Purpose of the Study:

  • Analyze early and late survival in elderly patients undergoing mitral valve replacement.
  • Evaluate surgical outcomes in a center prioritizing valve replacement.
  • Compare observed survival with expected survival in the general population.

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 rates in Uruguay's general population.
  • Multivariate analysis to identify predictors of operative mortality and survival.

Main Results:

  • Global 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: 70.2% for females (similar to expected) vs. 40.1% for males (lower than expected).
  • Predictors of survival included earlier surgery (pre-2006) and female sex.

Conclusions:

  • Mitral valve replacement is a feasible and effective option for elderly patients with mitral valve disease.
  • Centers focusing on valve replacement can achieve low operative mortality and favorable survival, particularly in females.
  • Surgical outcomes support mitral valve replacement as a viable treatment for elderly patients, challenging prior misconceptions.
Abstract

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