Mitral valve surgery in octogenarians: should we fight for repair? A survival and quality-of-life assessment

Abstract

Objective: The aim of the study was to evaluate survival and quality of life after mitral surgery in octogenarians.

Methods: From 1987 to 2007, 129 patients ≥ 80 years (median age 82 years; minimum 80 years and maximum 89 years) underwent mitral surgery (87.6% myxomatous, 10% rheumatic, and 2.3% ischemic) with repair procedure in 75 patients and replacement in 54 patients. In the repair and the replacement groups, respectively: Logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 5.77 (3.5-63) versus 11.1 (3.5-93.2); and significative preoperative differences were diabetes mellitus (1.3% vs 16.7%, p=0.002) and previous cardiac surgery (0% vs 16.7%, p=0.0001). Survival and quality of life (walking test) were assessed.

Results: In the repair and the replacement groups, respectively, hospital mortality (1 month) was 2.7% versus 18.5% (p=0.004). Early (1-6 months) mortality remained high with 9.6% versus 13.6% (p=0.55). Late mortality (6 months-7 years) was stable with an annual mortality of 8% versus 6% per year (p=0.32). The replacement procedure was the only significative predictor of mortality with an odds ratio (OR) of 6.7 (1.1-38.8 (p=0.04)) for operative mortality. Regarding quality of life, with 41 months' (1.1-180) (100%) follow-up, 54.2% (65.9%) of repair (replace) patients were living in a nursing home and walking distance without aid was more than 500 m in 67.1% (81.2%) of patients.

Conclusions: For elderly patients, 6-month mortality better reflects the burden of mitral surgery than the usual 1-month mortality. Even though replacement patients have higher operative estimated risk, mitral replacement remains, after adjustment, an independent predictor of higher operative mortality. Our results claim for wider use of repair technique in mitral surgery for the octogenarians, even if replacement is an acceptable option when repair is technically uncertain.