Mitral Valve Repair Versus Replacement in Octogenarians with Non-Ischemic Mitral Regurgitation
Joshua Manghelli, Daniel I. Carter, Ralph J. Damiano, Marc R. Moon, Nabil A. Munfakh, Spencer J. Melby, Washington University in St Louis, St. Louis, MO
OBJECTIVE: Recent data demonstrated that replacement of the mitral valve (MV) was equivalent for functional mitral regurgitation (MR). We questioned whether MVrepair remains the treatment of choice for degenerative MR in the elderly.
METHODS: Octogenarians with non-ischemic MR who underwent MVrepair or MVreplacement at two institutions between the years of 2004-2014 were retrospectively examined. Patients who had previous valve surgery, endocarditis, mitraclip procedure, and concomitant aortic valve replacement or coronary artery bypass grafting were excluded. The primary endpoint was 1 year mortality. Secondary endpoints included total length of hospital stay, time on ventilator, 30 day mortality, and other clinical outcomes.
RESULTS: 115 patients ‰¥80 years old underwent MVrepair or MVreplacement. 30-day/hospital mortality was 5.1% (n=4/78) and 13.5% (n=5/37) for MVrepair and MVreplacement groups, respectively (p=0.12). At 1 year, mortality for the MVrepair group was 12.8% (10/17) compared to 18.9 %(n=7/37) for the MVreplacement group (p=0.39) (Table 1). Ventilator time (p=0.04) and hospital length of stay (p=0.02) were significantly shorter in those with mitral repair (Table 1). Although postop sepsis, renal failure, post-op atrial fibrillation and stroke rates were higher in the MV replacement group, these were not statistically significant (Table 1).
CONCLUSIONS: Patients who underwent MVreplacement spent more hours on the ventilator and had longer hospital stays and showed trends toward higher short and long term mortality. MVrepair remains the treatment of choice for degenerative MV disease in octogenarians, when feasible.