Mitral Valve Repair versus Mitral Valve Replacement for Degenerative Mitral Valve Disease in Elderly Patients

Background: 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 option for patients with degenerative MV disease. Nevertheless, in elderly patients, there is still controversy if MV-repair improves outcomes of patients compared with mitral valve replacement (MVR). We reviewed results after MV surgery for degenerative 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. Survival data were obtained from the National Health Service central register and were complete for all patients. A comparative survival-analysis was performed for MV-repair and MVR patients.

Results: Of the 1776 patients identified, 244 patients were aged ≥75 years and had degenerative MV disease. Patients with repeat cardiac surgery, endocarditis and concomitant aortic valve replacement were excluded. In 124 patients, procedures were combined with coronary artery bypass grafting or tricuspid valve surgery (50.8%). MV-repair was performed in 171 patients and MVR in 73 patients. Mean age was 79.7 ± 3.0 years (MV-repair) vs 79.0 ± 3.2 years (MVR: p = 0.13). Median survival of all patients was 8.8 years, compared with a survival of 8.5 years (95%CI: 8.2–9.4) in the age matched UK population (Ratio 1.0). Thirty-day mortality was 2.9% (MV-repair) versus 5.5% (MVR, p = 0.46). Overall 1-, 2- and 5-year survival was 95.1%, 92.8% and 81.3%, respectively, in MV-repair versus 84.4%, 82.3% and 69.5% in MVR (p = 0.04). Rate of re-operation for MV-dysfunction was 2.9% (MV-repair) versus 0% (MVR, p = 0.33). After 6-weeks, re-admission for heart failure occurred in 7.6% (MV-repair) versus 2.7% (MVR, p = 0.24). At one year, freedom from significant MR was lower after MV-repair (91.8% versus 100%, p< 0.01).

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 patients with degenerative MV disease whenever possible.