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Midterm outcomes of mitral valve repair versus replacement in elderly patients: A propensity score-matched analysis

Brandon Muncan1, Andrea Amabile2, Andreas P Kalogeropoulos1

  • 1Division of Cardiology, Department of Medicine, Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA.

Journal of Cardiac Surgery
|September 28, 2022
PubMed
Abstract

Insights

Mitral valve repair in elderly patients shows lower 5-year mortality compared to replacement, with similar reoperation rates. This supports repair as a primary treatment option for mitral regurgitation in this age group.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Geriatric Medicine

Background:

  • Elderly patients undergoing mitral valve surgery have better short-term survival with repair versus replacement.
  • Long-term data on valve durability, complications, and reoperation rates after mitral valve repair in the elderly are limited.

Purpose of the Study:

  • To compare 5-year mortality and reoperation rates after mitral valve repair versus replacement in patients aged 70 years and older.

Main Methods:

  • A propensity score-matched analysis of 823 patients undergoing mitral valve repair and 823 undergoing replacement for nonrheumatic mitral insufficiency (2010-2020) using the TriNetX database.
  • Comparison of 5-year Kaplan-Meier mortality and reoperation rates between the matched cohorts.

Main Results:

  • Mitral valve repair was associated with significantly lower 5-year mortality (17.0% vs. 24.9%; HR: 0.66; p < 0.0025).
  • Five-year reoperation rates were similar between the repair and replacement groups (2.6% vs. 2.1%; HR: 1.34; p = 0.401).

Conclusions:

  • Mitral valve repair in elderly patients with mitral regurgitation is associated with reduced 5-year mortality compared to replacement.
  • Reoperation rates at 5 years were comparable, supporting mitral valve repair as a preferred initial treatment strategy in this population.
Keywords:
geriatricmitral regurgitationmitral valve repairmitral valve replacement

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