A propensity score-adjusted retrospective comparison of early and mid-term results of mitral valve repair versus replacement in octogenarians

Chikwe, Joanna; Goldstone, Andrew B.; Passage, Jürgen; Anyanwu, Anelechi C.; Seeburger, Joerg; Castillo, Javier G.; Filsoufi, Farzan; Mohr, Friedrich W.; Adams, David H.

doi:10.1093/eurheartj/ehq331

Cited by 146 publications

(122 citation statements)

References 23 publications

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“…However, they included patients with endocarditis (1.8% in MV‐repair and 13.7% in MVR) and had a higher rate of patients with ischemic MV disease (32.2% in MV‐repair) as compared to our cohort. The mean age of the study population was 83 years, which is higher than in our cohort and may also explain the difference in outcomes 12. Vassileva and colleagues showed a lower operative mortality in elderly patients of 3.9% for MV‐repair and 8.9% for MVR, but they reported only on outcomes of isolated MV procedures 8.…”

Section: Discussionmentioning

confidence: 62%

“…Moreover, the benefit of improved long‐term survival after MV‐repair is often believed not to apply in patients whose remaining life expectancy is naturally limited to less than 10 years. Published data on long‐term outcomes in elderly patients are contradictory, and the cohorts of MV‐repair and MVR in these reports often were not comparable 7, 10, 11, 12. While European and American guidelines in general favor MV‐repair over MVR, if a durable repair can be achieved, European guidelines do not address the elderly population with MV disease,13 and American guidelines recommend MV‐repair in patients >65 years only in the presence of symptomatic primary MV disease 14…”

Section: Introductionmentioning

confidence: 99%

“…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: 62%

Section: Introductionmentioning

confidence: 99%

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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“…The remaining 48 articles were selected for full-text reading, of which 41 reports that failed to meet the eligibility criteria were eliminated. Consequently, seven observational studies (11)(12)(13)(14)(15)(16)(17) that were published from 2004 to 2016 were included in our meta-analysis.…”

Section: Study Searchmentioning

confidence: 99%

Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

Shang¹,

Lü²,

Liu³

et al. 2017

J. Thorac. Dis.

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Background: Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population. 0.56-0.86). In addition, our study also demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR: 1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no difference in reoperations between these two surgery approaches. Conclusions:The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.

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“…The proportion of octogenarian patients with postoperative stroke following mitral valve repair was reported as 5.3% and 3.1% by Nloga, et al 21) and Chikwe, et al, respectively. 23) In our study, 2 patients showed intraoperative stroke, which may be related to aortic manipulation. Because elderly patients often have a diseased aorta, the cannulation site must be carefully selected.…”

Section: Discussionmentioning

confidence: 51%

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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A propensity score-adjusted retrospective comparison of early and mid-term results of mitral valve repair versus replacement in octogenarians

Cited by 146 publications

References 23 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

Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

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

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