Mitral Valve Repair for Severe Organic Mitral Regurgitation in the Elderly

Background and aim of the study: Although mitral valve repair has become the standard surgical procedure for mitral regurgitation (MR), the procedure does not necessarily apply to elderly patients aged >75 years because of high morbidity and mortality. Methods: A total of 104 patients aged >75 years who underwent mitral valve repair between January 1991 and December 2011 was reviewed retrospectively. The mean age was 78 years, and the mean follow up was 3.7 years. Possible risk factors for hospital death and morbidity were identified, and valve-related events during the follow up period were analyzed. Results: The overall hospital mortality rate was 4.8% (5/104). Multivariate logistic regression analysis identified serum creatinine level >2.0 mg/dl as the only independent predictor of hospital mortality. A total of 33 patients had postoperative complications. Infective endocarditis was the only independent predictor of hospital morbidity. Actual survival at five years was 85.6 +/- 4.1%. By Cox regression analysis, age (HR 1.195; p <0.012) proved to be a negative predictor of late survival, whereas the absence of chronic obstructive pulmonary disease (HR 0.129; p <0.014) was a positive predictor. Rates of freedom from thromboembolic events and bleeding at five years were 87.9 +/- 4.2% and 97.9 +/- 1.5%, respectively. Rates of freedom from moderate-to-severe MR and reoperation at five years were 80.3 +/- 6.5% and 97.5 +/- 2.5%, respectively. Conclusion: Late survival and freedom from valve-related events were favorable, in addition to hospital outcome, in patients aged >75 years. Mitral valve repair is an acceptable surgical procedure in terms of hospital mortality/morbidity and freedom from valve-related events.