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The Journal of Cardiovascular Surgery 2003 Aprile;44(2):157-61

lingua: Inglese

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


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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.

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