title: Mitral valve surgery in elderly patients with mitral regurgitation:  repair or replacement with tissue valve?
abstract: OBJECTIVE
  The fastest growing demographic in North America is the elderly. Significant mitral regurgitation is present in more than 10% of this population. There are sparse clinical data to inform decisions regarding the optimal timing of operation and the appropriate operative intervention for this large population of patients with severe mitral regurgitation.
  
  
  RESULTS
  Mitral valve surgery can be safely performed in most elderly patients with severe mitral regurgitation. The best outcomes occur when operative intervention is performed early, before advanced symptoms of heart failure develop. In elderly patients with mitral regurgitation, mitral valve repair is associated with superior early and late results compared with replacement. Survival after mitral valve repair among elderly patients is equivalent to a normal age-matched population.
  
  
  CONCLUSIONS
  Elderly patients with severe mitral regurgitation should be referred for operation before significant symptoms develop. Mitral valve repair is favoured over replacement whenever feasible and is associated with satisfactory early and long-term results. If repair is impossible or the likelihood of durable repair seems low, valve replacement with a bioprosthetic valve should be performed. Further prospective clinical trials are essential to define the role of screening for this prevalent condition and to identify which subgroups of elderly patients will benefit most from early surgical intervention.
authors: Department of Surgery, Division of Cardiac Surgery, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
authors: Mehrdad
authors: M
authors: Ghoreishi
authors: Murtaza Y
authors: MY
authors: Dawood
authors: James S
authors: JS
authors: Gammie
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome