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

Abstract

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.

Isolated and Combined Valve Surgery in Elderly Patients: A Comparison of Mid-Term Results

“…There has been increasing discussion on the greater risks of cardiac surgery for the elderly. [2][3][4][5][6] On the other hand, over the past decade, technical improvements in cardiac surgery, better methods of myocardial protection, and advances in perioperative care have made valve surgery a viable option even for elderly patients. 3,7) Combined valve surgery requires longer operative times because of time required for CPB and AXC.…”

Associations of increased arterial stiffness with left ventricular ejection performance and right ventricular systolic pressure in mitral regurgitation before and after surgery: Wave intensity analysis

“…However, the long term prognosis of surgically treated MR patients with PH, which included more aged patients, was still worse than that of patients without PH [23] . Murashita et al reported that preoperative PH disappeared after surgery in degenerative MR patients, and the leading cause of cardiovascular death after surgery was stroke, and most of patients who had recurrence of PH suffered from AF, which suggested recurrent PH after surgery was caused by different pathophysiology due to PH before surgery [24] .…”

(Meta)‐Analysis of Safety and Efficacy Following Edge‐to‐Edge Mitral Valve Repair Using the MitraClip System

“…Isolated oMVR for FMR is associated with an operative mortality between 0% and 7%. 6,23,24,[26][27][28] A recent publication which reviewed oMVP versus oMVR in elderly patients concluded despite the lack of RCT availability, oMVR was superior to oMVP with regards to mortality and postoperative complications. 29 The result suggest an advantage of oMVR compared to oMVP but randomized trials comparing oMVR with oMVP have been lacking.…”

“…Nevertheless, the authors give the recommendation of an individual assessment of oMVR in FMR. Isolated oMVR for FMR is associated with an operative mortality between 0% and 7% . A recent publication which reviewed oMVP versus oMVR in elderly patients concluded despite the lack of RCT availability, oMVR was superior to oMVP with regards to mortality and postoperative complications…”