A systematic review and meta-analysis of surgical outcomes following mitral valve surgery in octogenarians: implications for transcatheter mitral valve interventions

Abstract

Surgical treatment of MR in octogenarians is associated with high perioperative mortality and poor long-term survival with an uncertain benefit on quality of life. These data highlight the importance of patient selection for operative intervention and suggest that future transcatheter mitral valve therapies such as transcatheter mitral valve repair (TMVr) and/or transcatheter mitral valve implantation (TMVI), may provide an alternative therapeutic approach in selected high-risk elderly patients.

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

“…Another reason for improved outcomes in our cohort might be the routine preservation of the full or at least posterior subvalvular apparatus. This could also explain the superior long‐term survival of our cohort compared to 20% to 30% survival at 5 years observed for octogenarians in a recent meta‐analysis 18. Of note, the majority of studies included in this meta‐analysis consisted of historical cohorts from the 1990s.…”

“…In fact, the authors themselves state that the date of publication was linked to survival differences. Andalib and colleagues conclude on the basis of a pooled 30‐day mortality rate for MV‐repair of 6% that MV surgery may be associated with poor outcomes and uncertain benefit for quality of life in these patients 18. We strongly disagree with that conclusion, especially when made for MV‐repair.…”

Year in review

“…Of octogenarians who do undergo surgery, a meta-analysis of mitral surgery reported high perioperative mortality (13 and 7% for replacement and repair) and poor long-term survival (29 and 23% 5-year survival for replacement and repair) [29]. In vulnerable patient populations, less invasive transcatheter devices hold significant promise.…”

Mitralklappenstruktur und -funktion

“…Im Gegensatz zu den guten Ergebnissen der MKR bei DMR sind die chirurgischen Ergebnisse bei FMR eher ernüchternd [45,46]. In einer aktuellen Metaanalyse zeigen sich insbesondere für Patienten, die älter sind als 80 Jahre und die einer operativen Therapie bei hochgradiger Mitralinsuffizienz unterzogen wurden, ein deutlich erhöhtes perioperatives Risiko, keine Veränderung des langfristigen Überlebens sowie keine wesentliche Verbesserung der Lebensqualität [47,48]. Gerade bei diesen Patienten bietet sich daher ein interventionelles Verfahren an, falls Mitralklappenstruktur und -funktion ein solches Vorgehen erlauben.…”