title: Long-term survival of patients undergoing mitral valve repair and replacement: a longitudinal analysis of Medicare fee-for-service beneficiaries.
abstract: BACKGROUND
  Despite the established superiority of mitral repair over replacement, its adoption in the treatment of elderly patients has not been uniform, partly because of a lack of robust long-term survival data. We present the long-term survival of Medicare fee-for-service beneficiaries undergoing mitral valve repair and replacement over a 10-year period.
  
  
  RESULTS
  We used the Medicare database to identify 47 279 fee-for-service beneficiaries ≥65 years of age undergoing primary isolated mitral valve repair or replacement from 2000 to 2009. Operative mortality and long-term survival are presented for repair and replacement. Operative mortality was 3.9% for patients undergoing repair and 8.9% for patients undergoing replacement. The 1-, 5-, and 10-year Kaplan-Meier survival estimates for patients undergoing repair were 90.9%, 77.1%, and 53.6%. The 1-, 5-, and 10-year Kaplan-Meier survival estimates for patients undergoing replacement were 82.6%, 64.7%, and 37.2%. Important predictors of mitral repair included younger age (odds ratio, 1.10; 95% confidence interval, 1.05-1.14), elective admission status (odds ratio, 1.34; 95% confidence interval, 1.27-1.41), and annual mitral procedure volume >40 cases per year (odds ratio, 1.57; 95% confidence interval, 1.36-1.81). Female sex and the presence of comorbidities were associated with a lower likelihood of repair.
  
  
  CONCLUSIONS
  Mitral valve surgery in the Medicare population carries less risk than previously reported. Given the favorable outcomes of elderly patients undergoing mitral valve surgery, especially mitral valve repair, an approach of earlier identification and surgical referral appears justified regardless of age.
authors.affiliation: Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, 701 N First St, PO Box 19638, Springfield, IL 62794-9638, USA. cvassileva@siumed.edu
authors.forename: Christina M
authors.initials: CM
authors.lastname: Vassileva
authors.forename: Gregory
authors.initials: G
authors.lastname: Mishkel
authors.forename: Christian
authors.initials: C
authors.lastname: McNeely
authors.forename: Theresa
authors.initials: T
authors.lastname: Boley
authors.forename: Stephen
authors.initials: S
authors.lastname: Markwell
authors.forename: Steven
authors.initials: S
authors.lastname: Scaife
authors.forename: Stephen
authors.initials: S
authors.lastname: Hazelrigg
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018588:Fee-for-Service Plans / Q000639:trends*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality* / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D006278:Medicare / Q000639:trends*; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D017741:Survivors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: aged; mitral valve; outcomes research; surgery; valve repair