Surgical Correction of Mitral Regurgitation in the Elderly

Détaint, Delphine; Sundt, Thoralf M.; Nkomo, Vuyisile T.; Scott, Christopher G.; Tajik, A. Jamil; Schaff, Hartzell V.; Enríquez-Sarano, Maurice

doi:10.1161/circulationaha.106.619239

Cited by 144 publications

(94 citation statements)

References 39 publications

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“…In fact, the authors were able to show the improvement of outcomes over time in their study population, as operative mortality decreased from 27% to 5% in elderly patients. However, they did not make a direct comparison of MV‐repair to MVR 6. Another reason for improved outcomes in our cohort might be the routine preservation of the full or at least posterior subvalvular apparatus.…”

Section: Discussionmentioning

confidence: 89%

“…Therefore, although outcomes after MV surgery in elderly patients have improved markedly during recent years,6, 9, 12 the question of which surgical technique should be used remains unclear. In addition, innovative catheter‐based technologies increasingly address MV disease15 and should be measured against outcomes of conventional treatment options.…”

Section: Introductionmentioning

confidence: 99%

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

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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BackgroundBecause of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years.Methods and ResultsOur in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03).ConclusionsExcellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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“…10,[16][17][18] Detaint, et al reported that the repair rate has increased with time and exceeds 80% even in the elderly. 19) Some authors compared the surgical outcomes of repair and replacement and concluded that mitral valve repair was superior to replacement. 16,[18][19][20] Nloga, et al compared the surgical outcomes of mitral valve repair with those of replacement in octogenarians.…”

Section: Discussionmentioning

confidence: 99%

“…19) Some authors compared the surgical outcomes of repair and replacement and concluded that mitral valve repair was superior to replacement. 16,[18][19][20] Nloga, et al compared the surgical outcomes of mitral valve repair with those of replacement in octogenarians. They concluded that mitral valve replacement was an independent predictor of higher operative mortality.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Mitral Valve Repair for Degenerative Mitral Regurgitation in the Elderly

Murashita

Okada

Kanemitsu

et al. 2014

ATCS

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Purpose: The number of elderly patients who require surgical treatment for mitral regurgitation (MR) is increasing. However, the feasibility and efficacy of mitral valve repair in elderly patients are unclear. Methods: We retrospectively reviewed 55 patients, aged ≥75 years, who underwent mitral valve repair for degenerative MR between 1991 and 2011. All patients were followed up for 4.7 ± 3.4 years. Results: The patients aged ≥75 years were more symptomatic and had a higher incidence of persistent atrial fibrillation and pulmonary hypertension than those aged <75 years. Thirty-day and in-hospital mortality was 1.8% and 7.3%, respectively, and the 5-year survival rate was 81.6% ± 5.8%. The leading cause of late death was stroke, which primarily occurred in patients with postoperative atrial fibrillation. Except for a single failure of repair due to technical reasons, there was no recurrence of severe MR or reoperation on the mitral valve. In the late follow-up period, the mean left ventricular diastolic diameter significantly decreased and the mean left ventricular ejection fraction was approximately 60%. Most patients had mild symptoms at follow-up. Conclusion: Mitral valve repair can provide satisfactory early as well as long-term outcomes and can preserve left ventricular function even in the elderly.

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“…However, mitral valve repair (MVr) has become more popular, since mitral valve replacement (MVR) is associated with a high risk of thromboembolism, endocarditis, and left ventricular dysfunction. [7][8][9] Furthermore, it is necessary to use anticoagulants after MVR. In addition, MVr has a lower risk of thromboembolism and valvular infections, and requires less reoperation.…”

mentioning

confidence: 99%

A comparison of quality of life in mitral valve replacement and mitral valve repair patients

Arnaz¹

2017

Cardiovasc Surg Int

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Surgical Correction of Mitral Regurgitation in the Elderly

Cited by 144 publications

References 39 publications

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

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

Feasibility and Efficacy of Mitral Valve Repair for Degenerative Mitral Regurgitation in the Elderly

A comparison of quality of life in mitral valve replacement and mitral valve repair patients

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