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Canadian Journal of Cardiology

LONG-TERM DURABILITY OF SURGICAL MITRAL VALVE REPAIR FOR DEGENERATIVE DISEASE ACCORDING TO AGE AT SURGERY: INSIGHTS FROM > 1000 SURGICAL PROCEDURES

      BACKGROUND

      Mitral valve repair is the gold standard therapy for the treatment of degenerative mitral regurgitation (MR). Although outcomes following surgical mitral valve repair have been well described, few data are available on the longitudinal performance of mitral repair for patients according to the age at surgery. These data are particularly relevant in the era of percutaneous therapies, which are increasingly employed in younger patient groups. The purpose of this study was to report mortality and recurrent MR rates following mitral valve repair according to patient age at surgery.

      METHODS AND RESULTS

      We performed a retrospective cohort study with 1156 patients who underwent surgical mitral valve repair, in isolation or with concomitant procedures, for degenerative MR between 2003-2019. Clinical follow up was achieved through the University of Ottawa Heart Institute Mitral Valve Clinic. Echocardiographic follow up was performed at 1, 3, 6 and 12 months post-operatively and subsequently every 1-3 years or when clinically indicated. The mean patient age was 63.1±12.4 years and 320 (28%) were female. At the time of surgery, there were 51 patients < 40 years, 119 between 40-49, 245 between 50-59, 339 between 60-69, 304 between 70-79, and 98 >80 years. Clinical follow up averaged 4.7±4.0 years, with a total of 4776 postoperative transthoracic echocardiograms available for analysis in this cohort. Perioperative mortality for elective mitral valve repair was 1.3%. Ten-year freedom from recurrent MR that was at least moderate (≥2+) was 96±4%, 99±2%, 98±2%, 96±2%, 98±1%, and 92±5% for patients < 40 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and >80 years. Ten-year survival was 98±2%, 95±2%, 93±2%, 91±2%, 71±3%, and 34±9% for these age groups, respectively. Older age groups were more likely to have mitral annular calcification at the time of surgery (P < 0.001), although the incidence of complex bileaflet prolapse was not different (P=0.4). Although the age of a patient at surgery was associated with survival (P < 0.001), it was not associated with the development of recurrent MR ≥2+ (P=0.1).

      CONCLUSION

      These novel surgical data provide insights into the prognosis and performance of surgical mitral valve repair in patients with degenerative disease according to their age at operation. These data might be helpful in shaping indications for future catheter-based approaches.
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