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Isolated Minimally Invasive Mitral Valve Surgery in Octogenarians: Perioperative Outcome

Vasileios Ntinopoulos1, Hector Rodriguez Cetina Biefer1, Nestoras Papadopoulos1

  • 1Department of Cardiac Surgery, City Hospital of Zurich - Site Triemli, Zurich, Switzerland.

Gerontology
|August 30, 2023
PubMed
Abstract

Insights

Minimally invasive mitral valve surgery via right mini-thoracotomy is feasible and safe in octogenarians, demonstrating no mortality and low morbidity. This approach offers short procedure times and brief hospital stays for elderly patients undergoing mitral valve repair or replacement.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Geriatric Medicine

Background:

  • Mitral valve surgery is often performed via right mini-thoracotomy due to its feasibility, safety, and excellent outcomes.
  • However, data on its application in octogenarians (patients aged 80 and above) is limited.
  • This study addresses the paucity of information regarding the outcomes of this minimally invasive approach in this specific elderly demographic.

Purpose of the Study:

  • To assess the in-hospital perioperative outcomes of mitral valve surgery performed via right mini-thoracotomy in octogenarian patients.
  • To evaluate the feasibility, safety, and efficacy of this minimally invasive technique in an elderly population with severe mitral regurgitation.

Main Methods:

  • A retrospective analysis was conducted on 38 octogenarian patients who underwent isolated mitral valve surgery using the right mini-thoracotomy approach between 2013 and 2021.
  • Data collected included perioperative outcomes, procedure durations, and complication rates.
  • Patient demographics, including median age of 82 years and median EuroSCORE II of 3.1%, were recorded.

Main Results:

  • The study included 38 octogenarians (median age 82), with 50% undergoing mitral valve repair.
  • Key findings include short cardiopulmonary bypass (78 min) and aortic cross-clamping (57 min) times.
  • While no perioperative stroke or death occurred, complications included pacemaker implantation (31.6%) and reexploration for bleeding (13.2%).

Conclusions:

  • Mitral valve surgery via right mini-thoracotomy is feasible in octogenarians, characterized by short ischemic times and low overall in-hospital morbidity and mortality.
  • Increased risks of pacemaker implantation and reexploration for bleeding were observed.
  • Selecting valve replacement for high-risk repair cases may further reduce reoperations in this vulnerable patient group.
Keywords:
Minimally invasive surgeryMitral valveOctogenariansThoracotomy

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