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Survival Of Octogenarian Patients Undergoing Mitral Valve Repair For Degenerative Valve Disease.

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TITLE:  Survival Of Octogenarian Patients Undergoing Mitral Valve Repair For Degenerative Valve Disease.

OBJECTIVES:  Despite the superiority of mitral repair over replacement, and medical management, there has been a reluctance to recommend mitral repair for severe degenerative mitral regurgitation in the elderly population.  We aimed to evaluate our experience of mitral repairs in octogenarians and assess how survival compared to younger patients.

METHODS:  We performed a retrospective analysis of a prospectively collected database at a single institution between 2001-2012 (11 years).  Patients who had undergone first time mitral repair for degenerative mitral valve regurgitation were included, with or without concomitant CABG, tricuspid repair or AF ablation.  Patients were excluded if they had undergone concomitant AVR.  The cohort were arbitrarily divided into three groups; 1) <70 2)70-80 and 3) >80 years old.  Time to event survival analysis was performed with all-cause mortality as the outcome measure.  Multivariate Cox regression analyses was used to measure the associations between groups and all-cause mortality.  Unadjusted Kaplan-Meyer curves were used to show survival analysis. Risk estimates were presented as hazard ratios with 95% confidence intervals. Log rank tests were performed to compare survival curves.  Results for all analyses were considered statistically significant at p values < 0.05. Data analyses were performed using STATA 12®.

RESULTS:  A total of 615 patients (64% male) were included; 284 (46%) in Group 1, 257 (42%) in Group 2 and 74 (12%) patients in Group 3.  Concomitant CABG was undertaken in 20 patients (3.25%), tricuspid repair in 173(28%) and AF ablation in 31(5%).  Symptomatic status was 289 (47%) NYHA 1-2 and 326 (53%) NYHA 3-4.  Median follow up was 4.9 years (IQR 2.5-8.2 years).  In-hospital mortality was 2.8% in the total cohort and 1% for Group 1, 3.5% Group 2 and 6.7% for Group 3.  Cox regression analyses revealed that patients in Group 3 (> 80years) had an increased hazard ratio for all-cause mortality versus patients in Group 1(<70years) after adjusting for potential confounders (HR 3.4; 95% CI1.8-6.3, P<0.001).  There was a linear trend for higher mortality with increasing age category with a hazard ratio of 1.9 (95 % CI1.4-2.5, P<0.005) between each age category.  Unadjusted Kaplan-Meyer curves are displayed which shows that 5 year survival for Group 3 was 75%, not different from Group 2.  However, clear differences were observed between all three groups at 10 years with Group 3 having worst survival.

CONCLUSIONS:  We show that following mitral repair for severe degenerative mitral valve regurgitation, mid- to long-term survival for octogenarians is comparable to septuagenarians at 5 years, but then becomes increasing worse thereafter.  We conclude that patients being considered for mitral repair should not necessarily be turned down based on age.

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