Pushing the age limit: Mitral valve surgery is safe and effective in octogenarians

OBJECTIVE: Octogenarians represent a growing population of patients who require intervention for mitral valve disease. With the advent of transcatheter mitral approaches, the role of surgery, particularly valve repair, is under scrutiny. Comorbidity burden, poor tissue quality, and limited life expectancy have been cited as obstacles to benefiting from valve repair attempts. This study aims to capture outcomes of mitral valve surgery in octogenarians and compare outcomes of surgical valve repair and replacement. METHODS: All patients aged 80 years and older who underwent surgical mitral valve operations at a high-volume valve center were included in analysis. Analysis of all patients and subanalysis of patients with degenerative mitral regurgitation was conducted. Outcomes evaluated included operative mortality and midterm survival. RESULTS: Between 2015 and 2024, a total of 221 octogenarians underwent mitral surgery, including 158 (71%) undergoing mitral valve repair and 63 (29%) who underwent replacement for any etiology. Overall operative mortality was 5% (12 out of 221) (Society of Thoracic Surgeons Predicted Risk of Mortality, 5%) and was lower following mitral repair versus replacement (3% vs 11%; P = .04). On a subanalysis of 168 patients with degenerative mitral regurgitation (141 [84%] repair, 27 [16%] replacement), operative mortality was 1.2% (2 out of 168), with no difference by procedure type. Valve repair was associated with improved midterm survival for up to 4 years postsurgery (P = .02). CONCLUSIONS: Mitral surgery can be performed safely and effectively in appropriately selected octogenarians. Valve repair, when feasible, can promote improved midterm survival.