Surgical Treatment of Primary Mitral Regurgitation in the Elderly: Valve Replacement Versus Repair
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP065
Submission Type:
Abstract Submission
Authors:
Mikami Tsubasa (1), Masashi Kawamura (2), Noriyuki Kashiyama (3), Yoshito Ito (4), Yusuke Misumi (5), Ai Kawamura (6), Takuji Kawamura (3), Daisuke Yoshioka (7), Kazuo Shimamura (8), Shigeru Miyagawa (5)
Institutions:
(1) Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery, Osaka, Japan, (2) N/A, Suita, Osaka, Japan, (3) N/A, Osaka, (4) N/A, Mino, Japan, (5) Osaka University Hospital, Suita, Osaka, (6) N/A, N/A, (7) Osaka University Hospital, Osaka, (8) N/A, Suita
Submitting Author:
Tsubasa Mikami
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Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery
Osaka University Graduate School of Medicine, Department of Cardiovascular Surgery
Co-Author(s):
Masashi Kawamura
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Noriyuki Kashiyama
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Yoshito Ito
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Yusuke Misumi
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Osaka University Hospital
Osaka University Hospital
Ai Kawamura
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Takuji Kawamura
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Daisuke Yoshioka
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Osaka University Hospital
Osaka University Hospital
Kazuo Shimamura
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Shigeru Miyagawa
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Osaka University Hospital
Osaka University Hospital
Presenting Author:
Tsubasa Mikami
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Abstract:
Objective: Given the increasing number of elderly patients with primary MR who are candidates for mitral valve surgery, we sought to compare the short- and long-term outcomes of mitral valve repair (MVr) versus mitral valve replacement (MVR) for primary, especially Carpentier type II, MR in elderly patients.
Methods: All patients, age 70 years or greater, with Carpentier type II MR who underwent MVr or MVR between 2012 and 2021 at our institution were retrospectively identified. Short- and long-term outcomes were compared before and after propensity score (PS) matching.
Results: A total of 142 patients were included in the study. The median follow-up was 3.4 years. A total of 115 patients (81.0%) underwent MVr and 27 patients (19.0%) underwent MVR. Apart from age (MVr 76.8±4.3 years vs 78.9±4.3 years MVR, P=.03), preoperative NYHA classification III or IV (MVr 30 (26.1%) vs MVR 14 (51.9%), P=.01), preoperative atrial fibrillation (MVr 55 (47.8%) vs MVR 20 (74.1%), P=.01) and mitral valve complexity score (MVr 2.0±1.3 vs MVR 4.8±2.4, P<.01), there was no significant difference in terms of any other preoperative characteristics between the 2 groups. Postoperatively, patients in the MVR group had significantly longer intubation time (MVr 14 hours vs MVR 20 hours, P<.01) and hospital stay (MVr 16 days vs MVR 25 days, P<.01). The 30-day mortality was significantly higher for the MVR group (MVr 0.0% vs MVR 7.4%, P=.03). Overall survival and freedom from reoperation at 1 and 5 years showed no significant difference between the 2 groups (Survival: MVr vs MVR: 97.2% vs 92.6% at 1 year, 85.9% vs 64.1% at 5 years, P=.08; Freedom from reoperation: MVr vs MVR: 94.4% vs 100.0% at 1 year, 92.8% vs 90.9% at 5 years, P=.65). After PS matching, the 30-day mortality was not significantly higher for the MVR group (MVr 0.0% vs MVR 3.9%, P=1.00). Overall survival and freedom from reoperation at 1 and 5 years still showed no significant difference between the 2 groups (Survival: MVr vs MVR: 96.2% vs 96.2% at 1 year, 76.4% vs 66.6% at 5 years, P=.85; Freedom from reoperation: MVr vs MVR: 91.6% vs 100.0% at 1 year, 91.6% vs 90.9% at 5 years, P=.54).
Conclusions: Regarding mitral valve surgery for primary MR in the elderly, postoperative short- and long-term outcomes were similar between the 2 groups. For elderly patients with primary MR, the comparable prognosis as after MVr would be obtained if MVR is performed in selected cases.
Methods: All patients, age 70 years or greater, with Carpentier type II MR who underwent MVr or MVR between 2012 and 2021 at our institution were retrospectively identified. Short- and long-term outcomes were compared before and after propensity score (PS) matching.
Results: A total of 142 patients were included in the study. The median follow-up was 3.4 years. A total of 115 patients (81.0%) underwent MVr and 27 patients (19.0%) underwent MVR. Apart from age (MVr 76.8±4.3 years vs 78.9±4.3 years MVR, P=.03), preoperative NYHA classification III or IV (MVr 30 (26.1%) vs MVR 14 (51.9%), P=.01), preoperative atrial fibrillation (MVr 55 (47.8%) vs MVR 20 (74.1%), P=.01) and mitral valve complexity score (MVr 2.0±1.3 vs MVR 4.8±2.4, P<.01), there was no significant difference in terms of any other preoperative characteristics between the 2 groups. Postoperatively, patients in the MVR group had significantly longer intubation time (MVr 14 hours vs MVR 20 hours, P<.01) and hospital stay (MVr 16 days vs MVR 25 days, P<.01). The 30-day mortality was significantly higher for the MVR group (MVr 0.0% vs MVR 7.4%, P=.03). Overall survival and freedom from reoperation at 1 and 5 years showed no significant difference between the 2 groups (Survival: MVr vs MVR: 97.2% vs 92.6% at 1 year, 85.9% vs 64.1% at 5 years, P=.08; Freedom from reoperation: MVr vs MVR: 94.4% vs 100.0% at 1 year, 92.8% vs 90.9% at 5 years, P=.65). After PS matching, the 30-day mortality was not significantly higher for the MVR group (MVr 0.0% vs MVR 3.9%, P=1.00). Overall survival and freedom from reoperation at 1 and 5 years still showed no significant difference between the 2 groups (Survival: MVr vs MVR: 96.2% vs 96.2% at 1 year, 76.4% vs 66.6% at 5 years, P=.85; Freedom from reoperation: MVr vs MVR: 91.6% vs 100.0% at 1 year, 91.6% vs 90.9% at 5 years, P=.54).
Conclusions: Regarding mitral valve surgery for primary MR in the elderly, postoperative short- and long-term outcomes were similar between the 2 groups. For elderly patients with primary MR, the comparable prognosis as after MVr would be obtained if MVR is performed in selected cases.
Mitral Conclave:
Mitral Valve Replacement
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