Hospital morbidity and mortality and changes in quality of life following mitral valve surgery in the elderly.
OBJECTIVE
An increasing number of elderly patients are now requiring mitral valve surgery (MVS). However, due to a perceived increase in risk of morbidity and mortality following cardiac surgery, many elderly patients tend to be neglected or not referred for surgery.


METHODS
The outcome of MVS in terms of hospital morbidity and mortality, length of intensive care unit (ICU) and hospital stays, and change in NYHA functional class and quality of life following surgery was assessed in 43 elderly patients (18 males, 25 females; median age 77 years (IQR 75-82 years)) who underwent primary open mitral valve repair (MVRr) or replacement (MVR) between November 1994 and September 1997. Their preoperative clinical characteristics, incidence of hospital morbidity, hospital mortality and length of ICU and hospital stays following MVS were recorded. At follow up, NYHA class was assessed and quality of life parameters monitored using the SF-36 questionnaire.


RESULTS
At surgery, 69% of patients were in NYHA class III/IV, 36% underwent non-elective surgery and 44% had symptoms of more than three years' duration. Among patients, 80% presented with mitral incompetence and MVRr was undertaken in 51%. The median bypass and cross-clamp times for MVRr were significantly longer than for MVR. After surgery, 98% of patients required inotropic support, 9% renal dialysis, and 42% ventilatory support for >24 h. In addition, 37% developed respiratory complications, 12% renal failure, 19% needed re-exploration for bleeding, and 5% suffered a stroke. The mean ICU stay after surgery was three days; average in-hospital stay was 10 days. The 30-day mortality rate was 22.7% after MVRr and 38% after MVR. There was a significant improvement in energy, and role limitation due to physical and mental health after MVS.


CONCLUSIONS
Elderly patients underwent MVS, usually after a degree of clinical deterioration. Although morbidity and mortality following mitral valve surgery were high, at follow up there was a significant improvement in both symptoms and quality of life of survivors.
Goldsmith
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Department of Cardiothoracic Surgery, Walsgrave Hospital, Coventry, UK.
Lip
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Kaukuntla
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Patel
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D000368:Aged; D000369:Aged, 80 and over; D001705:Bioprosthesis; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000523:psychology; D002315:Cardiopulmonary Bypass; D004739:England / Q000453:epidemiology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000523:psychology; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D009017:Morbidity; D011788:Quality of Life; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D015996:Survival Rate