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Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation

Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milano, Italy

Received 29 August 2008; received in revised form 9 February 2009; accepted 18 February 2009.

^_* Corresponding author. Tel.: +39 02 26437111; fax: +39 02 26437125. (Email: francesco.maisano{at}hsr.it).

Objective: Mitral valve surgery for organic mitral regurgitation (MR) in the elderly has been debated. In the elderly, quality of life is a better indicator of surgical success than survival. We assessed quality of life of elderly patients submitted to surgery for MR using the Minnesota Living with Heart Failure (MLHF) questionnaire. Methods: Between August 2003 and August 2006, 225 consecutive patients >70 years old underwent surgical treatment of organic MR. Mean age was 77 ± 3.3 years (range 71–87 years). Mean EF was 50 ± 11%. Degenerative disease was the most prevalent (77%) etiology. CABG was associated in 25% of patients. Mean Charlson score was 4.3 ± 1.5 and 101 patients (45%) were NYHA class III and IV. Hospital survivors were followed up and quality of life by MLHF score was assessed. Results: Mitral repair and replacement were equally distributed in this population. Hospital mortality was 2.7%. Late survival was 91 ± 1.9% at 3 years. MLHF was obtained from 204 patients at mean 2 ± 1 years of follow-up. MLHF score was 38 ± 18; there were 135 (66%) patients with MLHF >30. MLHF tended to increase with age at follow-up (p = 0.007). Multivariable predictors of MLHF were preoperative atrial fibrillation (p = 0.019), diabetes (p = 0.03), higher creatinine level (p = 0.0009), higher EuroSCORE (p = 0.02), residual mitral regurgitation grade at follow-up echocardiography (p < 0.0001) and systolic pulmonary artery pressure at follow-up (p = 0.04). Type of surgical treatment (repair vs replacement and choice of prosthesis) did not predict MLHF at follow-up, although those who had recurrent MR after repair had the highest scores compared to patients who had repair and durable result and those treated by replacement (MLHF was 51 ± 21, vs 34 ± 16, vs 39 ± 18, respectively, p = 0.0013). Conclusions: Quality of life following mitral valve surgery is suboptimal in more than half of elderly patients. MLHF score at follow-up is mostly related to preoperative conditions. Type of surgery does not influence MLHF score, however, quality of life is worse in patients with recurrent/residual MR following repair.

Key Words: Mitral regurgitation • Mitral valve surgery • Mitral valve replacement • Mitral valve repair • Surgery in the elderly • Quality of life