Objective

Due to demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Mitral Valve Repair (MV-repair) is the gold-standard treatment for patients with MV disease. Nevertheless, in elderly patients, there is still controversy if MV-repair improves outcomes of patients compared to mitral valve replacement (MVR). We reviewed results after MV surgery for MV disease in elderly patients treated at our institution over the past 20 years.

Methods

Our in-hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Of the 1776 patients identified with MV disease, 341 patients were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis and concomitant aortic valve replacement were excluded. MV-repair was performed in 221 and MVR in 120 patients. A comparative survival-analysis was performed for MV-repair and MVR patients and repeated after propensity matching of the two cohorts.

Results

Concomitant procedures included coronary artery bypass grafting (39.6%) and tricuspid valve surgery (14.7%). Mean age was 79.2 ±3.0 yrs (MV-repair) vs 78.4 ±2.9 yrs (MVR, p=0.03). 30-day mortality was 5.4% vs. 9.2% (p=0.26). Overall 5-year survival was 74.2% vs. 61.0% (p<0.01). Median survival was 7.8 years (8.5years in the matched UK population). Rate of re-operation was 2.3% vs. 2.5% (p=1.0). After propensity matching survival at 2- and 5-years was 91.6%, 76.9% vs. 75.2%, 58.7% (p=0.03).

Conclusion

Excellent short- and long-term outcomes can be achieved after MV surgery in elderly patients. Long term survival is superior after MV-repair and the rate of re-operation is low. Therefore, MV-repair should be performed in elderly patients who undergo surgery for MV disease.