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Mitral valve surgery in the elderly
E M Lee1, J N Porter, L M Shapiro
1Regional Cardiac Unit, Papworth Hospital, Cambridge, UK.
The Journal of Heart Valve Disease
|January 1, 1997
Summary
Late mitral valve surgery, not age, significantly impacts outcomes in elderly patients. Early intervention and valve repair, when possible, lead to excellent medium-term results for both young and older individuals.
Area of Science:
- Cardiovascular Surgery
- Geriatric Cardiology
- Valvular Heart Disease
Background:
- Previous studies suggest poorer outcomes in elderly patients undergoing mitral valve surgery.
- These studies often failed to differentiate between age itself and associated comorbidities or surgical timing.
- This study investigates the independent and interactive effects of age and other factors on mitral valve surgery outcomes.
Purpose of the Study:
- To determine the relative contributions of advanced age versus age-associated factors to outcomes after mitral valve surgery.
- To compare outcomes between elderly (>=70 years) and younger (<70 years) adult patients undergoing mitral valve repair or replacement.
Main Methods:
- A comparative study of 190 elderly and 424 younger adult patients undergoing mitral valve surgery (repair or replacement).
- Baseline characteristics, operative details, and short-term and long-term outcomes were analyzed.
- Multivariate analysis was employed to identify independent predictors of survival and complications.
Main Results:
- Elderly patients presented with more comorbidities, including degenerative mitral regurgitation, coronary artery disease, and impaired left ventricular function.
- Operative mortality was low and similar in both age groups (3.7% vs. 3.5%).
- Seven-year survival was significantly poorer in the elderly, but freedom from complications-related death was excellent and similar in both groups when surgery was performed early in asymptomatic or mildly symptomatic patients with preserved left ventricular function.
Conclusions:
- Late surgical intervention, rather than advanced age itself, is the primary driver of poor outcomes in elderly patients undergoing mitral valve surgery.
- Prioritizing early surgery and mitral valve repair over replacement, when feasible, yields excellent medium-term results for both elderly and younger patients.
- Optimizing preoperative conditions, including New York Heart Association class and left ventricular function, is crucial for favorable surgical outcomes across all age groups.