Surgical correction of mitral regurgitation in the elderly - Outcomes and recent improvements

Background - In the elderly, mitral regurgitation (MR) is frequent, but surgery risks are considered high. Benefits and indications of MR surgery are uncertain in the elderly. Methods and Results - Baseline characteristics, outcome, and trends for surgical results improvement were analyzed in elderly patients (>= 75 years of age; n = 284) operated on for MR in 1980 to 1995 compared with younger patients ( 65 to 74 years of age, n = 504; and < 65 years of age, n = 556). Preoperatively, class III to IV symptoms, atrial fibrillation, coronary disease, creatinine, and comorbidity index were more severe in elderly patients ( all P < 0.002). In the long term after surgery, observed survival stratified by age (>= 75, 65 to 74, < 65 years) was lower in elderly than in younger patients ( at 5 years, 57 +/- 3%, 73 +/- 2%, and 85 +/- 2%, respectively; P < 0.001), but ratios of observed to expected survival were similar ( 83%, 85%, and 88%, respectively). In multivariate analysis adjusted to expected survival, elderly patients showed no difference in life expectancy restoration compared with younger patients ( adjusted hazard ratio, 0.89; 95% confidence interval, 0.73 to 1.30; P = 0.54). Temporal trends showed that risk of operative mortality, although higher in elderly patients ( P < 0.001), declined markedly for all ages (27% to 5% in those >= 75 years of age, P < 0.01; 21% to 4% in those 65 to 74 years of age, P < 0.01; and 7% to 2% in those < 65 years of age, P = 0.06), with a parallel decline in low cardiac output and length of hospital stay. Over time, valve repair feasibility increased in all age groups ( 30% to 84% overall and 31% to 93% in degenerative MR; P < 0.0001). Conclusions - Elderly patients undergoing MR surgery display more severe preoperative characteristics and incur higher operative risks than younger patients. However, restoration of life expectancy after surgery is similar in elderly and younger patients, and outstanding recent surgical improvements particularly benefited elderly patients. Thus, elderly patients with MR can now carefully be considered for surgery before refractory heart failure is present.