Outcomes of Mitral Valve Repair Versus Replacement in the Elderly

This study evaluated outcomes of mitral valve surgery (MVS) in the elderly.

Patients 75 years or older undergoing MVS at a single center between 2010 and 2018 were included. Patients were stratified into mitral valve repair (MVr) or replacement (MVR). The primary outcome was mortality. Secondary outcomes included postoperative complications, readmissions, and freedom from at least moderate mitral regurgitation. Multivariable Cox regression was used for risk adjustment. A subanalysis of isolated, non-reoperative MVS for degenerative disease was also performed.

Elderly patients (n = 472) underwent MVS, 301 (64%) with MVr and 171 (36%) with MVR. The majority of cases (68%) were performed for degenerative etiologic process. Survival was similar between MVr and MVR at 1 year (84% versus 86%; P = .40) and 5 years (64% versus 64%; P = .59). Postoperative complications were also comparable. Freedom from readmission was lower in the MVR cohort at 1 year (57% versus 68%; P = .02) and 5 years (33% versus 43%; P = .02). In isolated MVS for degenerative etiologic process, there was no difference in early or late mortality between MVr and MVR, although readmissions were lower with MVr. Overall, freedom from mitral valve reoperation was comparable, and the freedom from at least moderate regurgitation was 86% at 5 years in the MVr group.

This study indicates that the outcomes of elderly patients undergoing MVS are acceptable with approximately 64% survival at 5 years. Our data suggest that MVr in the elderly may not confer a survival advantage but can be performed with durable results.