10-YEAR EXPERIENCE WITH MITRAL-VALVE REPLACEMENT IN THE ELDERLY

Limited data are available on mitral valve replacement in the elderly patient. Therefore we report our 10-year experience including predictors of perioperative mortality and subsequent long-term cardiac mortality in elderly patients with mitral valve replacement compared to younger patients. Of the 126 consecutive patients with mitral valve replacement, 26 were older (77 +/- 4, group 1) and 100 were younger (62 +/- 9, group 2) than 70 years. Bioprostheses were used more frequently in patients in group 1 (65% vs 7%, p < 0.0001). Of the 21 clinical, ECG, hemodynamic, and angiographic variables studied, patients in group 1 had higher pulmonary artery systolic pressure (57 +/- 15 vs 48 +/- 19, p < 0.05), fascicular block on ECGs (70% vs 33%, p < 0.005), and greater pump time on cardiopulmonary bypass (160 +/- 75 vs 120 +/- 50 minutes, p < 0.025). A trend toward a higher perioperative mortality rate was also seen in group 1 (27% vs 12%, p = 0.058). Predictors of perioperative mortality by multivariate analysis were the presence of aortic calcification and prolonged pump time on cardiopulmonary bypass in group 1 and coronary artery disease, female sex, elevated mean pulmonary artery pressure, and postoperative complete atrioventricular block in group 2. During a mean 4-year follow-up period, cardiac mortality and total mortality rates were 42% and 54%, respectively, for group 1 compared to 24% and 35%, respectively, for group 2. Predictors of cardiac mortality by multivariate analysis were aortic calcification, pacemaker implantation, elevated mean pulmonary artery pressure, decreased left ventricular ejection fraction, and smaller prosthetic valve size in group 1 and female sex, coronary artery disease, perioperative atrioventricular block, age, and elevated mean pulmonary artery pressure in group 2. Thus elderly patients with mitral valve replacement have higher perioperative mortality and subsequent cardiac mortality than younger patients. Further studies comparing mitral valve replacement with valve repair and valvuloplasty seem indicated.