Abstract
Background: The increasing prevalence of degenerative and functional mitral valve disease as the population ages alongside introduction of percutaneous mitral valve interventions mandates revision of outcomes of mitral valve surgery (MVS) in elderly and high risk patients. We compared the characteristics and outcomes of octogenarians and septuagenarians undergoing MVS. Methods: All patients over 70 years of age having isolated MVS at Auckland City Hospital during 2005-2012 were studied and divided into 70-79 and >80 years age-groups for analysis. Results: There were 20 octogenarians and 81 septuagenarians studied. Apart from median age (82.0 vs. 74.0 years, P<0.001) and previous stroke (15.0% vs. 1.2%, P=0.024) respectively, there were no significant differences in pre-operative characteristics. Octogenarians however had significantly higher median EuroSCORE (4.5% vs. 3.4%, P=0.010) and STS Score (5.6 vs. 2.8%, P=0.002). Despite this, octogenarians had numerically but not statistically significantly less operative mortality (0.0% vs. 7.4%, P=0.340). One, three and five-year survivals were 100.0%, 80.0% and 70.0% for octogenarians and 91.4%, 86.4% and 73.8% septuagenarians. There was also no difference in composite and individual post-operative complications including stroke (P=0.358-1.000). The only independent predictor of operative mortality was cardiopulmonary bypass time odds ratio 1.02, 95% confidence interval 1.00-1.04, P=0.044. Conclusion: Although octogenarians were older with higher risk scores, they did not have increased mortality and morbidity from MVS. MVS remains a safe procedure in selected octogenarians, and other factors beyond age and risk scores such as frailty would be important in deciding the modality of mitral valve intervention in elderly patients.
Highlights
The world’s first successful heart valve surgery was performed in 1923 on a 12 year-old girl with rheumatic mitral stenosis, and twenty years later, John Gibbon performed the first successful open heart surgery using cardiopulmonary bypass, often considered the most important advancement in heart valve surgery [1, 2]
Higher median scores were found in the octogenarians compared to the septuagenarians for two of three risk models: EuroSCORE(11.4% and 7.0% respectively, P=0.01) and Society of Thoracic Surgeon (STS) score (5.6% and 2.8% respectively, P=0.02)
The main contributor to the higher EuroSCORE and STS Score in octogenarians was predominantly the age difference. This was a similar finding to our previous study of aortic valve replacement in elderly patients [12], and perhaps reflect a more cautious and conservative approach in selecting octogenarians for cardiac surgery compared to younger counterparts [13]
Summary
The world’s first successful heart valve surgery was performed in 1923 on a 12 year-old girl with rheumatic mitral stenosis, and twenty years later, John Gibbon performed the first successful open heart surgery using cardiopulmonary bypass, often considered the most important advancement in heart valve surgery [1, 2]. Further refinements of surgical techniques, recommended for treating severe symptomatic valvular heart disease, have since been developed to meet. The increasing prevalence of degenerative and functional mitral valve disease as the population ages alongside introduction of percutaneous mitral valve interventions mandates revision of outcomes of mitral valve surgery (MVS) in elderly and high risk patients. We compared the characteristics and outcomes of octogenarians and septuagenarians undergoing MVS
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