Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: Effect of age and concomitant coronary artery bypass grafting

A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement. A matched study was performed using prospectively collected data from the Emory cardiovascular database from 1984...

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Bibliographic Details
Published in:	Circulation (New York, N.Y.) Vol. 108; no. 3; pp. 298 - 304
Main Authors:	THOURANI, Vinod H, WEINTRAUB, William S, GUYTON, Robert A, JONES, Ellis L, WILLIAMS, Willis H, ELKABBANI, Sharif, CRAVER, Joseph M
Format:	Journal Article
Language:	English
Published:	Hagerstown, MD Lippincott Williams & Wilkins 22-07-2003 American Heart Association, Inc
Subjects:	Adult Age Factors Aged Biological and medical sciences Case-Control Studies Coronary Artery Bypass - mortality Coronary Artery Bypass - statistics & numerical data Coronary Artery Disease - mortality Coronary Artery Disease - surgery Databases as Topic Female Georgia - epidemiology Heart Valve Prosthesis Implantation - mortality Heart Valve Prosthesis Implantation - statistics & numerical data Hospital Mortality Humans Length of Stay - statistics & numerical data Male Matched-Pair Analysis Medical sciences Middle Aged Mitral Valve Insufficiency - mortality Mitral Valve Insufficiency - surgery Multivariate Analysis Prospective Studies Resource Allocation - statistics & numerical data Severity of Illness Index Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Survival Analysis Survivors - statistics & numerical data Treatment Outcome Georgia Human Mitral valve Prognosis Replacement Survival Plasty coronary disease Treatment Aortocoronary Bypass Follow up study Surgery Age
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Summary:	A paucity of literature is available on the effects of age and coronary artery bypass grafting (CABG) on the outcomes of patients undergoing mitral valve (MV) repair versus replacement. A matched study was performed using prospectively collected data from the Emory cardiovascular database from 1984 to 1997 comparing 625 MV repair patients with 625 MV replacement patients. Mean age was significantly higher in the replacement group (56+/-14 versus 55+/-14 years). Preoperative demographics and postoperative outcomes were similar between groups. Length of stay (LOS) was significantly less in the repair group (9.5+/-9.4 versus 12.3+/-13.1 days). In-hospital mortality was significantly less in the repair group (4.3% versus 6.9%), and overall 10-year survival was significantly higher in the repair group (62% versus 46%). Ten-year survival of patients <60 years of age was significantly higher in repair patients (81% versus 55%) but similar in patients > or =60 years of age (33% versus 36%, respectively). Ten-year survival of MV repair without CABG was significantly higher compared with MV replacement patients (74% versus 51%) but similar to patients with concomitant CABG (28% versus 34%, respectively). Independent predictors of long-term mortality included increasing age, urgent/emergent status, female sex, diabetes mellitus, increasing weight, heart failure, decreasing ejection fraction, concomitant CABG, and MV replacement. Mitral valve repair has reduced LOS and improved in-hospital and 10-year survival. However, in the present series, MV repair does not provide significant long-term survival benefit over MV replacement in patients older than 60 years of age or those requiring concomitant CABG.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0009-7322 1524-4539
DOI:	10.1161/01.CIR.0000079169.15862.13