title: Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression.
abstract: OBJECTIVE
  The authors evaluated the outcome of patients≥80 years undergoing mitral valve (MV) surgery.
  
  
  METHODS
  Systematic review of the literature and meta-analysis.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  METHODS
  None.
  
  
  RESULTS
  Twenty-four studies reporting on 5,572 patients ≥80 years of age who underwent MV surgery were included in this analysis. Pooled proportion of operative mortality was 15.0% (95% confidence interval [CI] 11.9-18.1), stroke was 3.9% (95% CI 2.6-5.2), and dialysis was 2.7% (95% CI 0.5-4.9). Early date of study (p = 0.014), increased age (p = 0.006), MV replacement (p = 0.008), procedure other than isolated MV surgery (p = 0.010), MV surgery associated with coronary artery surgery (p = 0.029), aortic cross-clamping time (p<0.001), and cardiopulmonary bypass time (p<0.001) were associated significantly with increased operative mortality. MV repair had lower operative mortality compared with MV replacement (7.3% v 14.2%, relative risk 0.573, 95% CI 0.342-0.962). Random-effects metaregression showed that prolonged aortic cross-clamping time (p = 0.005) was the only determinant of increased operative mortality, even when adjusted (p<0.001) for date of study (p = 0.004). Operative mortality was significantly higher in studies reporting a mean cross-clamp time >90 minutes (17.0% v 7.4%, p<0.001). Survival rates at 1, 3, and 5 years were 76.1%, 67.7%, and 56.5%, respectively.
  
  
  CONCLUSIONS
  MV surgery in patients ≥80 years of age is associated with operative mortality, which has decreased significantly during recent years. Prolonged aortic cross-clamp time is a major determinant of operative mortality. MV repair may achieve better results than MV replacement in the very elderly. Five-year survival of these patients is good and justifies surgical treatment of MV diseases in octogenarians.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. faustobiancari@yahoo.it
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.forename: Paola
authors.initials: P
authors.lastname: Schifano
authors.forename: Michele
authors.initials: M
authors.lastname: Pighi
authors.forename: Francesco
authors.initials: F
authors.lastname: Vasques
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.forename: Giulia
authors.initials: G
authors.lastname: Vinco
mesh_terms: D000369:Aged, 80 and over / Q000706:statistics & numerical data*; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data*; D002315:Cardiopulmonary Bypass; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012044:Regression Analysis; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D016019:Survival Analysis; D016896:Treatment Outcome