MP65. Surgical Treatment of Primary Mitral Regurgitation in the Elderly: Valve Replacement Versus Repair
Presented During: Moderated E-Posters
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Clinical Fellow, Department of Cardiovascular Surgery, Graduate School of Medicine, Osaka University
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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.