Mitral valve replacement in the elderly is associated with low mortality and similar survival to the general population.

Background: With the increase of elderly population, cardiologists and surgeons are faced with an increased incidence of mitral regurgitation. Most of these patients are denied surgery due to a misconceived perception of ominous surgical results. Our objective was to analyze early and late survival in elderly patients after mitral valve surgery in a center in which replacement is the procedure of choice.

Methods: We obtained clinical follow-up of patients older than 70 years who underwent first-time isolated replacement from January 2000 to January 2012. Observed survival was compared with expected survival in the general population of Uruguay. Independent predictors of operative mortality and survival were determined.

Results: A total of 127 patients were included. Global operative mortality was 9.4% (1.8% after year 2006 vs. 15.3% before 2006; P<0.05). Surgery performed before 2006, preoperative hematocrit and creatinine were independent predictors for operative mortality after multivariate analysis. 6-year survival was 70.2% for females (72.4% expected survival, P=ns) and 40.1% in males (63.5% expected survival, P<0.05). Independent predictors of survival were surgery performed before 2006 (HR=3.2) and female sex (HR=0.4).

Conclusion: Mitral valve replacement is a feasible option for elderly patients with mitral valve disease in centers with lack expertise in valve repair. Actual surgical results provide low operative mortality and similar survival to general the population (mainly in females).