Ailawadi Gorav, Swenson Brian R, Girotti Micah E, Gazoni Leo M, Peeler Benjamin B, Kern John A, Fedoruk Lynn M, Kron Irving L
Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
Ann Thorac Surg. 2008 Jul;86(1):77-85; discussion 86. doi: 10.1016/j.athoracsur.2008.03.020.
Mitral valve replacement is more frequently performed and perceived to be equivalent to repair in elderly patients, despite the superiority of repair in younger patients. Our objective was to compare mitral repair to replacement in elderly patients age 75 years or older. Patients younger than 75 years undergoing mitral valve surgery served as a reference population.
Consecutive elderly patients undergoing operation for mitral regurgitation at our institution from 1998 to 2006 were reviewed. Elderly patients (mean age, 78.0 +/- 2.8 years) who underwent mitral repair (n = 70) or replacement (n = 47) were compared with cohorts of young patients (mean age, 58.9 +/- 9.3 years) who underwent repair (n = 100) or replacement (n = 98) during the same period. Patient details and outcomes were compared using univariate, multivariate, and Kaplan-Meier analyses.
Mitral replacement in elderly patients had higher mortality than repair (23.4%, 11 of 47 versus 7.1%, 5 of 70; p = 0.01) or as compared with either operation in the reference group (p < 0.0001). Postoperative stroke was higher in elderly replacement patients compared with repair (12.8%, 6 of 47 versus 0%; p = 0.003) or compared with either young cohort (p = 0.02). Compared with elderly repair patients, elderly replacement patients had more cerebrovascular disease (21.3%, 10 of 47 versus 4.3%, 3 of 70; p = 0.005) and rheumatic mitral valves (21.3%, 10 of 47 versus 0%; p = 0.0001). In the young group, overall complication and mortality were no different between replacement and repair. Long-term survival favored repair over replacement in elderly patients (p = 0.04). One elderly repair patient experienced late recurrence of persistent mitral regurgitation.
In patients age 75 years or older, mitral repair is associated with a lower risk of mortality, postoperative stroke, and prolonged intensive care unit and hospital stay compared with mitral replacement. Mitral repair can be performed in preference over replacement even in patients older than the age of 75.
二尖瓣置换术在老年患者中更为常见，且被认为与修复术效果相当，尽管修复术在年轻患者中更具优势。我们的目的是比较75岁及以上老年患者的二尖瓣修复术与置换术。年龄小于75岁接受二尖瓣手术的患者作为参照人群。
回顾了1998年至2006年在我们机构接受二尖瓣反流手术的连续老年患者。将接受二尖瓣修复术（n = 70）或置换术（n = 47）的老年患者（平均年龄78.0±2.8岁）与同期接受修复术（n = 100）或置换术（n = 98）的年轻患者队列（平均年龄58.9±9.3岁）进行比较。使用单因素、多因素和Kaplan-Meier分析比较患者的详细信息和结果。
老年患者二尖瓣置换术的死亡率高于修复术（23.4%，47例中有11例；7.1%，70例中有5例；p = 0.01），或与参照组的任何一种手术相比（p < 0.0001）。老年置换患者术后中风发生率高于修复患者（12.8%，47例中有6例；0%；p = 0.003），或与任何一个年轻队列相比（p = 0.02）。与老年修复患者相比，老年置换患者有更多的脑血管疾病（21.3%，47例中有10例；4.3%，70例中有3例；p = 0.005）和风湿性二尖瓣（21.3%，47例中有10例；0%；p = 0.0001）。在年轻组中，置换术和修复术的总体并发症和死亡率没有差异。老年患者长期生存方面，修复术优于置换术（p = 0.04）。一名老年修复患者出现持续性二尖瓣反流的晚期复发。
在75岁及以上患者中，与二尖瓣置换术相比，二尖瓣修复术的死亡风险、术后中风风险以及重症监护病房和住院时间延长的风险更低。即使在年龄超过75岁的患者中，二尖瓣修复术也可优先于置换术进行。
