Late results of mitral valve reconstruction in the elderly

Background. This study attempts to confirm favorable results with mitral va lve reconstruction (MVP) in patients greater than or equal to 70 years of a ge and to examine complication rates by actual analysis. Methods. Between Tune of 1980 and December of 1997, 278 patients 70 years o f age or older (mean, 75.2 years; range, 70 to 87 years) underwent MVP for mitral regurgitation. Most involved insertion of an annuloplasty ring. Conc omitant procedures were performed in 72.3%, and 55.0% required coronary rev ascularization. Results. For isolated MVP, the in-hospital mortality rate was 6.5% and 17.0 % when combined with coronary revascularization. The mortality rate when co mbined with another valve procedure was 13.2%. The 5-year freedom from late cardiac death. was 100% in the isolated MVP group and 79.7% for MVP with a concomitant procedure (p = 0.006). Complications were analyzed using actua l (cumulative incidence) analysis to eliminate the competing risk of noncar diac death. Mean NYHA class improved from 3.32 to 1.71 postoperatively. Rep air failure was rare, with a 5-year freedom from reoperation of 91.2%. Conclusions. These findings confirm the favorable outcome of MVP in elderly patients. Late repair failures are rare; comorbid disease is an important predictor of outcome. (C) 2000 by The Society of Thoracic Surgeons.