Surgery for Common Heart Valve Condition In Elderly Is Safe, Restores Longevity

Mitral valve repair in the elderly is safe and should be considered not as a last resort but as a treatment option for patients older than 65 suffering from mitral regurgitation, according to findings of a large, multicenter study that analyzed more than 14,000 valve repair operations among this age group.

Mitral regurgitation, or a leaking mitral valve in the heart, can significantly limit long-term life expectancy and reduce quality of life because of its secondary effects. Young patients suffering from mit ral regurgitation have their valves repaired as a first course of treatment. However, current treatment guidelines in elderly patients call for medical treatments to be tried first because advanced age was believed to put these patients at high risk for complications and little was known about their long-term outcomes. Mitral valve repair often was only done in the elderly once symptoms worsened.

“We found that mitral repair in older individuals is well tolerated, with low mortality and low morbidity, and that reoperations are uncommon. Most importantly, following mitral repair, a patient’s 10-year survival is restored to the normal matched U.S. population,” said Vinay Badhwar, a professor of surgery in the Department of Cardiothoracic Surgery in Pitt’s School of Medicine and the study’s lead author. Badhwar presented the findings as the J. Maxwell Chamberlain Memorial Paper for Adult Cardiac Surgery at the opening of the annual meeting of The Society of Thoracic Surgeons in Fort Lauderdale, Fla., on Jan. 30.

Researchers in the study analyzed clinical data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database matched to longitudinal claims data from the Centers for Medicare and Medicaid Services; they identified 14,604 isolated nonemergent primary mitral valve repair operations between 1991 and 2007. The cases were studied for mortality, mitral reoperation, and readmissions for heart failure, bleeding, and stroke.

The number of patients who died during or soon after surgery was only 2.6 percent and survival during follow-up was 74 percent. After adjusting for the statistical impact of late mortality, the researchers found that mitral repair was durable, with reoperation occurring in only 5 percent of cases.

“The results indicate that age alone should not be a marker of high risk in isolated mitral valve disease, and that there should be some careful thought given when medical therapy is considered over mitral repair in older patients,” said Badhwar, who is also codirector of both the UPMC Center for Mitral Valve Disease and the UPMC Center for Atrial Fibrillation. “Based on these data, guideline recommendations for medical therapy for symptomatic mitral regurgitation based on age alone should be re-evaluated.”

Also participating in the study were researchers from All Children’s Hospital, Cardiac Surgical Associates of Florida, The Congenital Heart Institute of Florida, the Duke Clinical Research Institute, Massachusetts General Hospital, the University of Colorado, the University of Florida, the University of Maryland, the University of Michigan, and the University of South Florida College of Medicine.

The study was supported by The Society of Thoracic Surgeons Research Center through the Adult National Cardiac Database and the Duke Clinical Research Institute.