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[Mitral valve re-replacement in patients aged 70 years and older: is age alone not operative risk factor?]
T Asakura1, K Aoki, M Tadokoro
1Department of Surgery, Cardiovascular Institute, Tokyo, Japan.
Abstract:
We analyzed the risk of mitral valve re-replacement (re-MVR) in patients over 70-year-old. Surgical and late follow-up results were compared between 14 elderly patients over 70-year-old (group I) and 23 patients aged from 60 to 69-year-old (group II) who underwent re-MVR due to primary tissue failure (PTF). Donation of autologous blood and a rate of replaced valve prosthesis (mechanical/biological) were different between the two groups. There were no differences in the other factors such as clinical profile, preoperative organ function, operative characteristics, post operative relating factors. No operative death occurred in both groups. There was one hospital death in group I (a hospital mortality rate of 7.1%). The cause of death was related to massive cerebral infarction due to anticoagulant-related thromboembolic event. 4-64 months after re-MVR, the improvement of a NYHA function class was I-II in the two groups. With improvement in myocardial protection and intraoperative strategies, the operative risk in patients undergoing re-MVR over 70-year-old has been markedly reduced. Surgical results in aged patients were satisfactory and age alone is not a contraindication for this operation. The re-MVR in aged patients should be done at the early stage of PTF before progress of cardiac failure.
Insights
Elderly patients over 70 undergoing mitral valve re-replacement (re-MVR) due to primary tissue failure (PTF) showed satisfactory surgical results. Age is not a contraindication for re-MVR, especially when performed early to prevent cardiac failure progression.
Area of Science:
- Cardiology
- Cardiac Surgery
- Geriatric Medicine
Background:
- Mitral valve re-replacement (re-MVR) is increasingly performed in elderly patients.
- Primary tissue failure (PTF) is a common indication for re-MVR.
- The safety and efficacy of re-MVR in patients over 70 require further investigation.
Purpose of the Study:
- To analyze the risk and outcomes of mitral valve re-replacement (re-MVR) in patients over 70 years old.
- To compare surgical and late follow-up results between elderly patients (>70) and younger elderly patients (60-69) undergoing re-MVR for primary tissue failure (PTF).
Main Methods:
- Retrospective analysis comparing two groups: 14 patients over 70 (group I) and 23 patients aged 60-69 (group II).
- Both groups underwent re-MVR due to primary tissue failure (PTF).
- Comparison of clinical profiles, organ function, operative characteristics, postoperative factors, and outcomes.
Main Results:
- No operative deaths occurred in either group.
- One hospital death (7.1%) in the >70 group due to cerebral infarction.
- Significant improvement in NYHA function class (I-II) observed in both groups 4-64 months post-re-MVR.
Conclusions:
- Operative risk for re-MVR in patients over 70 has been reduced with improved myocardial protection and surgical strategies.
- Surgical results for elderly patients undergoing re-MVR are satisfactory, indicating age alone is not a contraindication.
- Early re-MVR for primary tissue failure in aged patients is recommended before significant cardiac failure develops.