Surgery for Common Heart Valve Condition in Elderly is Safe, Restores Longevity

Mitral regurgitation, or a leaking mitral valve in the heart, can significantly limit long-term life expectancy and reduce quality of life due to its secondary effects. Young patients suffering from mitral regurgitation have their valves repaired as a first course of treatment. However, current treatment guidelines in elderly patients call for medical treatments to be tried first because advanced age was believed to put these patients at high risk for complications and little was known about their long-term outcomes. Mitral valve repair often was only done in the elderly once symptoms worsened.

“We found that mitral repair in older individuals is well tolerated, with low mortality, low morbidity and that reoperations are uncommon. Most importantly, following mitral repair, patient’s 10-year survival is restored to the normal matched U.S. population,” said Vinay Badhwar, M.D., co-director, UPMC Center for Mitral Valve Disease, the study’s lead author. He presented the findings at the opening of the Annual Meeting of The Society of Thoracic Surgeons in Fort Lauderdale, Fla., on January 30 as the J. Maxwell Chamberlain Memorial Paper for Adult Cardiac Surgery.

Researchers in the study analyzed clinical data from The Society of Thoracic Surgeons Adult Cardiac Surgery Database matched to longitudinal claims data from the Centers for Medicare and Medicaid Services and identified 14,604 isolated non-emergent primary mitral valve repair operations between 1991 and 2007. The cases were studied for mortality, mitral reoperation and readmissions for heart failure, bleeding and stroke.

The number of patients who died during or soon after surgery was only 2.6 percent and that survival during follow-up was 74 percent. Also, the 10-year actuarial survival was restored to the normal matched U.S. population, Dr. Badhwar said. After adjusting for the statistical impact of late mortality, the researchers found that mitral repair was durable, with reoperation occurring in only 5 percent of cases.

“The results indicate that age alone should not be a marker of high risk in isolated mitral valve disease and that there should be some careful thought given when medical therapy is considered over mitral repair in older patients,” said Dr. Badhwar, also co-director of the UPMC Center for Atrial Fibrillation and associate professor of Surgery in the Department of Cardiothoracic Surgery at the University of Pittsburgh School of Medicine. “Based on these data, guideline recommendations for medical therapy for symptomatic mitral regurgitation based on age alone should be re-evaluated.”

Collaborators on the study were Eric D. Peterson, M.D.; Xia He, M.Sc.; J. Matthew Brennan, M.D.; Sean M. O’Brien, Ph.D.; and Rachel S. Dokholyan, M.P.H., all of the Duke Clinical Research Institute; Jeffrey P. Jacobs, M.D., of The  Congenital Heart Institute of Florida, All Children’s Hospital, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida; Steven F. Bolling, M.D., University of Michigan;  David M. Shahian, M.D., Massachusetts General Hospital; Fredrick L. Grover, M.D., University of Colorado;  Fred H. Edwards, M.D., University of Florida; and James S. Gammie, M.D., University of Maryland.

The study was supported by The Society of Thoracic Surgeons Research Center through the Adult National Cardiac Database and the Duke Clinical Research Institute.