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THE JOURNAL OF CARDIOVASCULAR SURGERY
Rivista di Chirurgia Cardiaca, Vascolare e Toracica
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2003 Aprile;44(2):157-61
Mitral valve repair in the elderly: operative risk for patients over 70 years of age is acceptable
Lee R. 1, Sundt III T. M. 2, Moon M. R. 1, Pasque M. K. 1, Barner H. B. 1, Damiano R. J. 1, Gay W. A. Jr. 1
1 Division of Cardiothoracic Surgery Department of Surgery Washington University School of Medicine St. Louis, MO, USA
2 Division of Cardiovascular Surgery Mayo Clinic, Rochester, MN, USA
Aim. Mitral valve repair for degenerative disease is widely accepted. Because of low risk and excellent late outcomes, surgical intervention is recommended increasingly early when repair appears possible. The place of repair vis a vis continued medical therapy in the elderly, however, is less well defined as there are scant data on their surgical risk. We reviewed our recent results with mitral valvuloplasty for degenerative disease with attention to the influence of age.
Methods. Thirty-day results of mitral valvuloplasty for degenerative disease between January 1996 and April 2000 were examined retrospectively. Patients with ischemic etiology were excluded. Results among those over age 70 years were compared with younger patients.
Results. Of 140 patients (78 men and 62 women) aged 27 to 91 (mean 62±13) years (44≥70 years of age), 61 underwent isolated mitral valvuloplasty, 71 mitral valvuloplasty and coronary artery bypass, and 8 mitral valvuloplasty with other procedures. By multivariate analysis preoperative cardiogenic shock (0.001), but not age, was as a risk factor for death. Among patients stratified by age ≥ or <70, there were differences in atrial fibrillation (47.7% vs 29.2%, p=0.03), prolonged ventilation (31.8% vs 15.6%, p=0.03) and hospital stay (median 9.5, range 5-285 vs median 6.5, range 2-36, p=0.001), but not 30-day readmission (15.9% vs 22.9%) or death (5.2% vs 9.1%, p=0.49).
Conclusion. Operative results for mitral valvuloplasty in the elderly are acceptable. Surgery should not be withheld on the basis of age alone.