Early and mid-term clinical outcome in younger and elderly patients undergoing mitral valve repair with or without tricuspid valve repair

Abstract

Objectives: Data regarding durability and midterm benefits of mitral valve (MV) repair in elderly patients are scarce. To evaluate the feasibility and safety of MV repair in elderly patients, we performed a retrospective data analysis.

Methods: We compared clinical outcomes in younger patients (<75 years: n = 462) and older patients (≥75 years: n = 100) undergoing MV repair with or without tricuspid valve (TV) repair. The primary end-point was 30-day mortality.

Results: The preoperative risk profile (EuroSCORE, NYHA class, percentage pulmonary hypertension, percentage diabetes) was higher in older patients compared with younger patients. Nevertheless, operative complications such as low cardiac output syndrome, stroke, infections, the need of haemofiltration and IABP use did not differ significantly between the two groups. The thirty-day mortality rate was 0% in older patients and 1% in younger patients (P = 0.30). In the subgroup of patients with double valve repair, the 30-day mortality rate in older patients (n = 28) and younger patients (n = 46) was 0 and 4%, respectively (P = 0.27). In older and younger patients, the 6-month mortality rate was 4 and 2%, respectively (P = 0.16), and the 1-year mortality rate was 10 and 3%, respectively (P = 0.001). The propensity score-adjusted odds ratio of 1-year mortality with the group of younger patients as a reference was 2.04 (95% confidence interval: 0.77-5.40; P = 0.15) for older patients. Freedom from 1-year reoperation did not differ significantly between age groups.

Conclusions: Data demonstrate excellent postoperative mortality rates in older patients undergoing MV repair with or without TV repair. Consequently, even in older patients with numerous comorbidities, MV repair should be considered a suitable surgical method.

Keywords: Age; Mitral valve; Mortality; Tricuspid valve; Valve repair.