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Eur J Cardiothorac Surg 2005;28:83-87
© 2005 Elsevier Science NL

Is mitral valve surgery safe in octogenarians?

^a University of Alberta Hospital, Edmonton, Alta., Canada
^b University of Calgary Foothills Hospital, Calgary, Alberta, Canada

Received 14 September 2004; received in revised form 2 December 2004; accepted 13 December 2004.

^* Corresponding author. Address: 2D4.37 Walter MacKenzie Center, Edmonton, Alta., Canada, T6G 2B7. Tel.: +1 780 407 8047; fax: +1 780 407 8054. (Email: jnagendr{at}ualberta.ca).

Objective: To evaluate the outcomes of mitral valve surgery in octogenarians. Methods: Data were collected prospectively from January 1996 to March 2004 at two surgical centers. Of 1386 consecutive patients with mitral valve surgery, 58 (4.2%) were aged 80 years. Survival data were analyzed using Cox proportional hazards modeling and Kaplan–Meier actuarial log rank statistics. Results: Octogenarians were similar to younger patients for the presence of pre-operative hypertension, hyperlipidemia, diabetes mellitus, and smoking history. Octogenarians had a higher incidence of cerebrovascular disease (19.0 versus 7.8%, P=0.003), urgent in-hospital surgery (55.2 versus 28.6%, P<0.001), and presence of ischemic disease requiring combined mitral valve plus revascularization surgery (72.4 versus 41.0%, P<0.001). Mitral valve repair was performed in a similar proportion of octogenarians and younger patients (44.8 versus 45.6%). Thirty-day mortality for octogenarians was significantly higher than younger patients (15.5 versus 5.6%, P=0.002), and actuarial survival of octogenarians was significantly decreased (P=0.009). However, 52.3% of the octogenarians were alive at 7-years following surgery. Independent predictors of mortality from multivariate risk adjusted modeling of the entire cohort were: emergency surgery (hazards ratio [HR]=2.94, P<0.001), combined mitral valve plus revascularization surgery (HR=2.27, P<0.001), mitral valve replacement (HR=1.85, P<0.01), and age 80 years (HR=1.80, P=0.02). Conclusions: Octogenarians undergoing mitral valve surgery have significantly greater incidence of urgent surgery, ischemic disease requiring combined revascularization surgery, and have decreased rates of survival. While caution is required when operating on these higher risk elderly patients, overall 52.3% of the octogenarians are alive at 7-years following surgery, which is greater than the survival of octogenarians in the community. The greatest survival benefit within octogenarians occurred when mitral valve repair was possible over replacement. Further study will more clearly define subgroups of octogenarians with potentially greater benefit from mitral valve surgery.

Key Words: Valve • Elderly • Survival

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