title: A systematic review and meta-analysis of surgical outcomes following mitral valve surgery in octogenarians: implications for transcatheter mitral valve interventions.
abstract: OBJECTIVE
  To evaluate the outcomes of mitral valve surgery in octogenarians with severe symptomatic mitral regurgitation (MR).
  
  
  RESULTS
  We performed a systematic review and meta-analysis of data on octogenarians who underwent mitral valve replacement (MVR) or mitral valve repair (MVRpr). Our search yielded 16 retrospective studies. Using Bayesian hierarchical models, we estimated the pooled proportion of 30-day mortality, postoperative stroke, and long-term survival. The pooled proportion of 30-day postoperative mortality was 13% following MVR (10 studies, 3,105 patients, 95% credible interval [CI] 9-18%), and 7% following MVRpr (six studies, 2,642 patients, 95% CI: 3-12%). Furthermore, pooled proportions of postoperative stroke were 4% (six studies, 2,945 patients, 95% CI: 3-7%) and 3% (three studies, 348 patients, 95% CI: 1-8%) for patients undergoing MVR and MVRpr, respectively. Pooled survival rates at one and five years following MVR (four studies, 250 patients) were 67% (95% CI: 50-80%) and 29% (95% CI: 16-47%), and following MVRpr (three studies, 333 patients) were 69% (95% CI: 50-83%) and 23% (95% CI: 12-39%), respectively.
  
  
  CONCLUSIONS
  Surgical treatment of MR in octogenarians is associated with high perioperative mortality and poor long-term survival with an uncertain benefit on quality of life. These data highlight the importance of patient selection for operative intervention and suggest that future transcatheter mitral valve therapies such as transcatheter mitral valve repair (TMVr) and/or transcatheter mitral valve implantation (TMVI), may provide an alternative therapeutic approach in selected high-risk elderly patients.
authors.affiliation: Department of Medicine, Division of Cardiology, Interventional Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Ali
authors.initials: A
authors.lastname: Andalib
authors.forename: Samuel
authors.initials: S
authors.lastname: Mamane
authors.forename: Ian
authors.initials: I
authors.lastname: Schiller
authors.forename: Andrea
authors.initials: A
authors.lastname: Zakem
authors.forename: Darren
authors.initials: D
authors.lastname: Mylotte
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martucci
authors.forename: Pascal
authors.initials: P
authors.lastname: Lauzier
authors.forename: Waleed
authors.initials: W
authors.lastname: Alharbi
authors.forename: Renzo
authors.initials: R
authors.lastname: Cecere
authors.forename: Magdalena
authors.initials: M
authors.lastname: Dorfmeister
authors.forename: Ruediger
authors.initials: R
authors.lastname: Lange
authors.forename: James
authors.initials: J
authors.lastname: Brophy
authors.forename: Nicolo
authors.initials: N
authors.lastname: Piazza
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000379:methods*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome