title: Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short- and Long-Term Outcomes in a Propensity-Matched Cohort.
abstract: Because of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV-repair) is the "gold standard" treatment for MV disease, in elderly patients, there is controversy about whether MV-repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years.
  
  
  
  Our in-hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV-repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty-day mortality was 5.4% (MV-repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1- and 5-year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV-repair was 7.8 years, close to 8.5 years (95% CI: 8.2-9.4) in the age-matched UK population (ratio 0.9). Rate of re-operation for MV-dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV-repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03).
  
  
  
  Excellent outcomes can be achieved after MV surgery in elderly patients. Long-term survival is superior after MV-repair and the re-operation rate is low. MV-repair should be the preferred surgical approach in elderly patients.
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Miriam
authors.initials: M
authors.lastname: Silaschi
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Chaubey
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Aldalati
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Habib
authors.initials: H
authors.lastname: Khan
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Mohammed Mohsin
authors.initials: MM
authors.lastname: Uzzaman
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Mrinal
authors.initials: M
authors.lastname: Singh
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Max
authors.initials: M
authors.lastname: Baghai
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Deshpande
authors.affiliation: Department of Cardiothoracic Surgery and Cardiology, King's College Hospital, London, UK olaf.wendler@nhs.net.
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods* / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D057216:Propensity Score; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: mitral valve; surgery; survival