Ten-year experience with mitral valve replacement in the elderly

Nair, Chandra K.; Biddle, William; Kaneshige, Alan M.; Cook, Corneila; Ryschon, Kay; Sketch, Michael H.

doi:10.1016/0002-8703(92)90934-n

“…Postoperative complications occurred in 57% and mean hospital stay was 16 days. Nair et al found a 27% perioperative mortality in 26 patients aged over 70, compared with 12% in younger patients25: at five years after mitral valve replacement 54% of their elderly patients had died. Edmunds et al had a 90 day mortality of 29% in octogenarians undergoing valve replacement 26.…”

Section: Discussionmentioning

confidence: 99%

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Sutaria

¹

,

Elder²,

Shaw³

2000

Heart

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Objective-To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. Design-Pre-and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. Setting-Tertiary referral centre in Scotland. Subjects-80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. Main outcome measures-Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. Results-Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1.59 (0.67) cm 2 . There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. Conclusions-Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement. (Heart 2000;83:433-438)

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“…Older patients with mitral stenosis are operated on at a more advanced stage of the disease and have pulmonary hypertension and associated comorbidity. Nair et al 3 reported a 27% perioperative mortality in 26 patients aged 70 years and older undergoing MVR, predominantly for mitral regurgitation, compared with 12% in younger patients. At 4‐year follow up, 54% of their older patients had died.…”

Section: Discussionmentioning

confidence: 99%

“…Data from surgical series indicate that very old patients undergoing mitral valve replacement or repair experience a higher mortality and morbidity and spend a longer time in the hospital than younger patients 3,4 . Since its introduction in 1984, 5 MBV has been used extensively for the treatment of rheumatic mitral stenosis in younger patients with pliant valves, with results comparable to surgical open and closed commissurotomy 6,7 .…”

mentioning

confidence: 99%

Mitral Balloon Valvotomy for the Treatment of Mitral Stenosis in Octogenarians

Sutaria

¹

,

Elder

²

2000

J American Geriatrics Society

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“…Postoperative complications occurred in 57% and mean hospital stay was 16 days. Nair et al found a 27% perioperative mortality in 26 patients aged over 70, compared with 12% in younger patients 25 : at five years after mitral valve replacement 54% of their elderly patients had died. Edmunds et al had a 90 day mortality of 29% in octogenarians undergoing valve replacement.…”

Section: Discussionmentioning

confidence: 99%

Exclusion of a pulmonary artery aneurysm using a covered stent

Wilson¹,

McLeod²,

Hallworth³

2000

Heart

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Objective-To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. Design-Pre-and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. Setting-Tertiary referral centre in Scotland. Subjects-80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. Main outcome measures-Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. Results-Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1.59 (0.67) cm 2 . There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. Conclusions-Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement. (Heart 2000;83:433-438)

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Ten-year experience with mitral valve replacement in the elderly

Cited by 15 publications

References 12 publications

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

Mitral Balloon Valvotomy for the Treatment of Mitral Stenosis in Octogenarians

Exclusion of a pulmonary artery aneurysm using a covered stent

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