title: Mitral valve repair versus replacement in the elderly population.
abstract: OBJECTIVE
  The study aim was to evaluate the available literature comparing mitral valve repair (MVRep) versus mitral valve replacement (MVR) in the elderly population, and to provide a pooled analysis regarding this issue.
  
  
  METHODS
  Medline, Embase, Cochrane, trial registries, conference proceedings and reference lists were searched for trials of MVRep versus MVR surgery in the elderly population. The primary outcome was 30-day mortality, while secondary outcomes were postoperative complications and length of hospital stay. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes.
  
  
  RESULTS
  Four studies retrieved were deemed appropriate for inclusion. The outcome measures used for the analysis clearly showed a benefit of MVRep in the elderly population with reduced mortality (pooled Odds Ratio (OR) = 3.97; p = 0.003) and reduced postoperative complications (pooled OR = 2.35; p = 0.003). There was no significant difference between the two groups with regards to duration of hospital stay (weighted mean difference = 0.22; p = 0.18).
  
  
  CONCLUSIONS
  With the demonstration of clear advantages of MVRep over MVR in the elderly population, a randomized trial between the two techniques is not ethically justifiable. As there are clear advantages to MVRep, it is recommended that this should be the primary treatment offered in mitral valve pathology, irrespective of the patient's age.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, UK.
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Umar
authors.initials: U
authors.lastname: Sadat
authors.forename: Lynn
authors.initials: L
authors.lastname: Edmonds
authors.forename: Sukumaran K
authors.initials: SK
authors.lastname: Nair
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D004739:England; D019317:Evidence-Based Medicine; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D016017:Odds Ratio; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome