MEDLINE/PubMed Journal Browser Search

Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

Title: Results of mitral surgery in octogenarians with isolated nonrheumatic mitral regurgitation.
Author: DiGregorio V, Zehr KJ, Orszulak TA, Mullany CJ, Daly RC, Dearani JA, Schaff HV.
Journal: Ann Thorac Surg; 2004 Sep; 78(3):807-13; discussion 813-4. PubMed ID: 15336996.
Abstract:
BACKGROUND: Increasing numbers of elderly patients are now referred for mitral valve operations. It has been unclear whether the results offset the risk of intervention in this patient population. METHODS: We obtained clinical follow-up through May 2002 of 59 patients 80 years or older who underwent first-time isolated mitral valve repair (46 patients) or replacement (13 patients) for nonischemic, nonrheumatic mitral regurgitation from January 1990 to June 2000. The mean duration of follow-up was 68 +/- 33 months. Observed survival was compared with the expected survival of persons of the same age and gender in the general population. RESULTS: Preoperatively 79% of patients were in New York Heart Association (NYHA) class III-IV. Operative mortality was 1.7%. Overall 1- and 5-year survival was 89% and 61%. One- and 5-year freedom from thromboembolic complications in hospital survivors was 97% and 84%. One- and 5-year freedom from heart-related hospitalization in hospital survivors was 89% and 78%. There were no reoperations. Twenty-nine patients underwent an echocardiographic follow-up; 31% of them exhibited moderate or more regurgitation. Of 37 surviving patients at follow-up, 78% were in NYHA functional class I-II. No statistically significant difference was noted between the observed survival postoperatively and the expected survival of persons of the same age and gender in the general population. In a univariate analysis, only preoperative left ventricular ejection fraction greater than 40% was significantly associated with freedom from late heart-related mortality (95% confidence interval 62%-92%, p = 0.01) and with freedom from heart-related hospitalization (95% CI 68%-95%, p < 0.01). CONCLUSIONS: Native mitral valve surgery for isolated nonischemic, nonrheumatic disease in octogenarians resulted in a survival rate comparable with that of the general population. It also exhibited substantial improvement regarding the functional status of the patient. Reparative techniques did not result in a survival advantage compared with replacement but did prove to be a reliable approach. Surgery performed in an early stage, preceding the development of left ventricular dysfunction, was associated with an improved freedom from late cardiac complications.

[Abstract] [Full Text] [Related] [New Search]