PMID- 15336996
OWN - NLM
STAT- MEDLINE
DCOM- 20050711
LR  - 20220311
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 78
IP  - 3
DP  - 2004 Sep
TI  - Results of mitral surgery in octogenarians with isolated nonrheumatic mitral 
      regurgitation.
PG  - 807-13; discussion 813-4
AB  - 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.
FAU - DiGregorio, Vincenzo
AU  - DiGregorio V
AD  - Division of Cardiovascular Surgery, Mayo College of Medicine, Rochester, 
      Minnesota, USA.
FAU - Zehr, Kenton J
AU  - Zehr KJ
FAU - Orszulak, Thomas A
AU  - Orszulak TA
FAU - Mullany, Charles J
AU  - Mullany CJ
FAU - Daly, Richard C
AU  - Daly RC
FAU - Dearani, Joseph A
AU  - Dearani JA
FAU - Schaff, Hartzell V
AU  - Schaff HV
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Mitral Valve Insufficiency/*mortality/*surgery
MH  - Survival Rate
MH  - Treatment Outcome
EDAT- 2004/09/01 05:00
MHDA- 2005/07/12 09:00
CRDT- 2004/09/01 05:00
PHST- 2004/03/15 00:00 [accepted]
PHST- 2004/09/01 05:00 [pubmed]
PHST- 2005/07/12 09:00 [medline]
PHST- 2004/09/01 05:00 [entrez]
AID - S0003497504006976 [pii]
AID - 10.1016/j.athoracsur.2004.03.041 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2004 Sep;78(3):807-13; discussion 813-4. doi: 
      10.1016/j.athoracsur.2004.03.041.