Key result
Postoperative complications in patients ≥80 years are driven by comorbidities rather than age alone.
Why the study?
The average age of patients undergoing mitral valve repair is increasing and the impact of age versus comorbidities on postoperative outcomes is unclear.
Does advanced age (≥80 years) independently increase in-hospital postoperative complications in adults undergoing mitral valve repair?
Cohort (n=308)
No
Does advanced age (≥80 years) independently increase in-hospital postoperative complications in adults undergoing mitral valve repair?
In patients undergoing mitral valve repair, increased postoperative complications in octogenarians are primarily driven by underlying comorbidities rather than age alone, emphasizing the need for comprehensive comorbidity-based preoperative risk assessment.
Comorbidities should guide mitral valve repair risk assessment over age alone; leaves open independent effects in larger prospective cohorts.
The average age of patients undergoing mitral valve repair is increasing each year. This retrospective study aimed to compare postoperative complications of mitral valve repair (known to be especially high-risk) between 2 age groups: under and over the age of 80.Patients who underwent mitral valve repair were divided into 2 groups: group 1 (<80 years old) and group 2 (≥80 years old). Baseline characteristics, pre- and postoperative hemodynamic data, surgical characteristics, and postoperative follow-up data until hospital discharge were collected.A total of 308 patients were included: 264 in group 1 (age 63 ± 13 years) and 44 in group 2 (age 83 ± 2 years). Older patients had more comorbidities (atrial fibrillation, history of cardiac decompensation, systemic hypertension, pulmonary hypertension, and chronic kidney disease) and they presented more postoperative complications (50.0% vs 33.7%; P = 0.043), with a longer hospital stay (8.9 ± 6.9 vs 6.6 ± 4.6 days; P = 0.005). To assess the burden of age, a propensity score was awarded to postoperative complications. Active smoking, chronic pulmonary disease, chronic kidney disease, associated ischemic heart disease, obesity, and cardio pulmonary by-pass duration were described as independent risk factors. When matched on this propensity score, there was no difference in morbidity or mortality between group 1 and group 2.Older patients suffered more postoperative complications, which were related to their comorbidities and not only to their age.
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Bonnet et al. (2016) conducted a cohort in Mitral valve disease requiring surgical repair (n=308). Age ≥80 years vs. Age <80 years was evaluated on In-hospital occurrence of a postoperative complication (≥2 specified postoperative events) (p=0.043). Age ≥80 years was associated with a higher unadjusted rate of complications (50.0% vs 33.7%, p=0.043) compared to <80 years, but propensity matching showed this was driven by comorbidities, not age.
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