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Published on: November 28, 2018
Early outcome of endoscopic mitral valve surgery in elderly patients: a high-volume single center experience
Jonas Pausch1, Oliver D Bhadra1, Xiaoqin Hua1
1Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
Introduction:
Despite increasing use of transcatheter approaches, endoscopic mitral valve surgery (MVS) remains an established option for treatment of mitral regurgitation (MR). Nevertheless, as perioperative risk increases with age, outcome of endoscopic MVS in elderly patients is uncertain.
Methods:
We retrospectively analyzed 756 consecutive patients with MR ≥2, who underwent minimally-invasive MVS at our institution between 2016 and 2022. Patients were stratified by age ≥75 (elderly-group; n = 91) or <75 years (control-group; n = 665). All patients received endoscopic MVS via right anterolateral minithoracotomy with non-rib spreading soft tissue retraction and 3D-camera visualization.
Results:
Overall surgical risk was increased in the elderly-group (median age of 77 (76-80) years vs. 58 (51-67) years, p < 0.001) with STS-PROM Scores of 1.9% vs. 0.4% (p < 0.001) and increased prevalence of hypertension, diabetes, coronary artery disease and atrial fibrillation (AFib). Elderly patients were also more symptomatic (NYHA class III 45.7% vs. 29.8%; p = 0.002). Axillo-femoral perfusion was more frequently used in the elderly-group (27.5% vs. 4.2%; p < 0.001). Cross-clamp and cardiopulmonary bypass times were similar. Rate of MV repair was 85.7% vs. 93.8% (p = 0.005). Closure of the left atrial appendage was more frequently performed in the elderly-group (45.1% vs. 23.9%; p < 0.001), whereas rate of concomitant tricuspid valve repair was similar (11.0% vs. 8.9%; p = 0.511). Postoperative complications including perioperative hemodialysis (3.3% vs. 2.9%; p = 0.739), low cardiac output (5.3% vs. 3.8%; p = 0.393), perioperative stroke (1.1% vs. 0.15%; p = 0.224) and myocardial infarction (0% vs. 0.15%) were favorably low in both groups. Acute mortality at 30 days was 2.2% vs. 0.4% (p = 0.112).
Conclusion:
Despite increased prevalence of outcome-relevant comorbidities and surgical risk, perioperative outcome of patients aged ≥75 years undergoing endoscopic MVS is favorable. Therefore, endoscopic MVS is a valuable therapeutic option for selected elderly patients and should be taken in consideration during routine heart-team discussion.
Insights
Endoscopic mitral valve surgery (MVS) is a viable option for elderly patients (≥75 years) with mitral regurgitation. Despite higher surgical risk, outcomes are favorable, supporting its consideration in heart-team discussions.
Area of Science:
- Cardiac Surgery
- Minimally Invasive Procedures
- Geriatric Cardiology
Background:
- Endoscopic mitral valve surgery (MVS) is an established treatment for mitral regurgitation (MR).
- Perioperative risk in MVS increases with patient age, raising concerns about outcomes in elderly individuals.
- Transcatheter approaches are increasingly used, but the role of endoscopic MVS in older populations remains under investigation.
Purpose of the Study:
- To evaluate the perioperative outcomes of endoscopic MVS in elderly patients (≥75 years) compared to younger patients.
- To determine if advanced age is a contraindication for minimally invasive mitral valve surgery.
- To assess the safety and efficacy of endoscopic MVS in a high-risk geriatric population.
Main Methods:
- Retrospective analysis of 756 patients undergoing endoscopic MVS for MR (≥2) between 2016-2022.
- Stratification into elderly (≥75 years, n=91) and control (<75 years, n=665) groups.
- Endoscopic MVS performed via right anterolateral minithoracotomy with 3D-camera visualization.
Main Results:
- Elderly patients had higher surgical risk (STS-PROM 1.9% vs. 0.4%) and more comorbidities (hypertension, diabetes, CAD, AFib).
- Despite increased risk, postoperative complications (hemodialysis, low cardiac output, stroke, MI) and 30-day mortality (2.2% vs. 0.4%) were low and comparable between groups.
- Mitral valve repair rates were slightly lower in the elderly (85.7% vs. 93.8%), with more frequent left atrial appendage closure.
Conclusions:
- Endoscopic MVS demonstrates favorable perioperative outcomes in patients aged ≥75 years, even with increased comorbidities and surgical risk.
- This minimally invasive approach is a valuable therapeutic option for carefully selected elderly patients with MR.
- Endoscopic MVS should be considered in routine heart-team discussions for eligible geriatric patients requiring mitral valve intervention.
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