Mitral valve surgery in the elderly.

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 ( 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 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.