PMID- 9044072
OWN - NLM
STAT- MEDLINE
DCOM- 19970502
LR  - 20071115
IS  - 0966-8519 (Print)
IS  - 0966-8519 (Linking)
VI  - 6
IP  - 1
DP  - 1997 Jan
TI  - Mitral valve surgery in the elderly.
PG  - 22-31
AB  - BACKGROUND AND AIMS OF THE STUDY: Previous studies have shown that outcome from 
      mitral valve surgery is poorer in the elderly. However, such studies did not 
      distinguish between age itself, age-associated factors and interactions between 
      age and other factors. We aimed to examine the relative influences of age and 
      these other factors on outcome. METHODS: We compared outcomes from mitral valve 
      repair or replacement in 190 elderly (> or = 70 years) and 424 younger (< 70 
      years) consecutive adult patients. RESULTS: At baseline, the elderly had more (p 
      > 0.05) degenerative mitral regurgitation, coronary artery disease, left 
      ventricular impairment, New York Heart Association (NYHA) class III or IV 
      symptoms, bioprosthetic replacement and mitral valve repair. Operative mortality 
      rate was low both in elderly (7/190 patients, 3.7%) and younger patients (15/424 
      patients, 3.5%, NS). Seven-year survival was poorer in the elderly with respect 
      to overall survival, (49 +/- 6% vs. 72 +/- 3%, p = 0.0001), freedom from 
      complications-related death (57 +/- 7% vs. 79 +/- 3%, p = 0.001), from death due 
      to myocardial failure (66 +/- 6% vs. 86 +/- 3%, p < 0.0001) and from overt 
      myocardial failure (44 +/- 7% vs. 74 +/- 3%, p = 0.0001). Multivariate analysis 
      showed better survival with younger age, mitral valve repair, better preoperative 
      NYHA class and better left ventricular function. However, 7-year freedom from 
      complications-related death was excellent and similar in both elderly (90 +/- 7%) 
      and younger (93 +/- 3%, NS) patients who underwent surgery early while in NYHA 
      class I or II with left ventricular ejection fraction > 40%. CONCLUSIONS: Late 
      surgery contributes far more than age itself to poor outcome from mitral valve 
      surgery in the elderly. If surgery is performed early and repair preferred to 
      replacement whenever feasible, medium-term results are excellent in both young 
      and old.
FAU - Lee, E M
AU  - Lee EM
AD  - Regional Cardiac Unit, Papworth Hospital, Cambridge, UK.
FAU - Porter, J N
AU  - Porter JN
FAU - Shapiro, L M
AU  - Shapiro LM
FAU - Wells, F C
AU  - Wells FC
LA  - eng
PT  - Journal Article
PL  - England
TA  - J Heart Valve Dis
JT  - The Journal of heart valve disease
JID - 9312096
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Bioprosthesis
MH  - Coronary Disease/complications
MH  - Echocardiography
MH  - Female
MH  - Heart Failure/mortality
MH  - Heart Valve Prosthesis
MH  - Humans
MH  - Male
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/surgery
MH  - Postoperative Complications/mortality
MH  - Survival Rate
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications
EDAT- 1997/01/01 00:00
MHDA- 1997/01/01 00:01
CRDT- 1997/01/01 00:00
PHST- 1997/01/01 00:00 [pubmed]
PHST- 1997/01/01 00:01 [medline]
PHST- 1997/01/01 00:00 [entrez]
PST - ppublish
SO  - J Heart Valve Dis. 1997 Jan;6(1):22-31.