Objective

Mitral Valve (MV) surgery is the standard treatment for MV disease. During past decades interventional treatments were implemented, raising awareness of MV treatment particularly in the elderly patient group. We analysed changes of referral patterns, baseline characteristics and outcomes of elderly patients undergoing MV surgery during the past two decades.

Methods

Our in-hospital database was retrospectively explored for patients treated surgically for MV disease. This yielded 1788 patients between 1994 and 2015. Of those 471 patients (26.3%) were aged ≥75 years. This group was further divided into two cohorts according to year of surgery, Decade-1 (1994-2005, total n=701, ≥75ys n= 113/16.1%) and Decade-2 (2006-2015, total n=1087, ≥75ys n= 358/32.9%).

Results

Patient age increased from 77.8±3.0ys (Decade-1) to 79.6±3.1ys (Decade-2, p<0.01). Patients treated in Decade-1 were more often in NYHA class IV (22.1% vs. 5.0%, p<0.01) and were more likely to have impaired LV-Function (37.2% vs. 11.7%, p<0.01). Proportion of degenerative disease increased (43.4% vs. 56.7%, p=0.01). The rate of MV-repair for degenerative disease increased (p<0.01). Postoperative 1-, 12- and 24 months survival improved (87.9%, 75.7%, 72.9% vs. 92.9%, 87.1%, 83.6%, p=0.01).

Conclusion

During two decades of MV surgery, the number of elderly patients increased and their survival continuously improved. While they were referred earlier for surgery, valve pathology changed towards degenerative disease, concomitant procedures increased and MV-repair was achieved more frequently.