Mitral valve repair in elderly patients was associated with significantly higher 5-year survival compared to mitral valve replacement (76.9% vs 58.7%, P=0.03) after propensity matching.
Cohort (n=341)
Does mitral valve repair improve survival compared to mitral valve replacement in elderly patients (≥75 years) with mitral valve disease?
Mitral valve repair is associated with superior short- and long-term survival compared to mitral valve replacement in elderly patients, supporting its use as the preferred surgical approach in this demographic.
Absolute Event Rate: 76.9% vs 58.7%
p-value: p=0.03
BACKGROUND: Because 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 RESULTS: Our 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). CONCLUSIONS: Excellent 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.
Silaschi et al. (Thu,) conducted a cohort in Mitral valve disease (n=341). Mitral valve repair vs. Mitral valve replacement was evaluated on 5-year survival (propensity-matched) (p=0.03). Mitral valve repair in elderly patients was associated with significantly higher 5-year survival compared to mitral valve replacement (76.9% vs 58.7%, P=0.03) after propensity matching.
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