Mitral valve surgery in the elderly.

BACKGROUND AND AIMS OF THE STUDY

Previous studies have shown that outcome from mitral valve surgery is poorer in the elderly. However, such studies did not distinguish between age itself, age-associated factors and interactions between age and other factors. We aimed to examine the relative influences of age and these other factors on outcome.

METHODS

We compared outcomes from mitral valve repair or replacement in 190 elderly (> or = 70 years) and 424 younger (< 70 years) consecutive adult patients.

RESULTS

At baseline, the elderly had more (p > 0.05) degenerative mitral regurgitation, coronary artery disease, left ventricular impairment, New York Heart Association (NYHA) class III or IV symptoms, bioprosthetic replacement and mitral valve repair. Operative mortality rate was low both in elderly (7/190 patients, 3.7%) and younger patients (15/424 patients, 3.5%, NS). Seven-year survival was poorer in the elderly with respect to overall survival, (49 +/- 6% vs. 72 +/- 3%, p = 0.0001), freedom from complications-related death (57 +/- 7% vs. 79 +/- 3%, p = 0.001), from death due to myocardial failure (66 +/- 6% vs. 86 +/- 3%, p < 0.0001) and from overt myocardial failure (44 +/- 7% vs. 74 +/- 3%, p = 0.0001). Multivariate analysis showed better survival with younger age, mitral valve repair, better preoperative NYHA class and better left ventricular function. However, 7-year freedom from complications-related death was excellent and similar in both elderly (90 +/- 7%) and younger (93 +/- 3%, NS) patients who underwent surgery early while in NYHA class I or II with left ventricular ejection fraction > 40%.

CONCLUSIONS

Late surgery contributes far more than age itself to poor outcome from mitral valve surgery in the elderly. If surgery is performed early and repair preferred to replacement whenever feasible, medium-term results are excellent in both young and old.