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Mitral valve repair safe for older patients

U. PITTSBURGH (US) — Heart surgery to repair the mitral valve is safe and leads to a better quality of life for older patients previously considered too high risk for the operation, new research shows.

The findings provide much-needed data on patients 65 years and older that could guide future treatment recommendations for people with severe heart disease.

“It is widely accepted that mitral repair is the treatment of choice for people with severe heart disease caused by a leaking mitral valve, and it can restore life expectancy to normal,” says Vinay Badhwar, associate professor of surgery at the University of Pittsburgh.

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“However, in older patients, current guidelines recommend initial medical management of the disease, delaying surgery until symptoms are very advanced. In some cases, delays in surgery can lower quality of life and make the eventual surgery riskier as the patient’s health further deteriorates.”

Badhwar and colleagues collected national data on 14,604 people age 65 and older who had mitral valve repair operations between 1991 and 2007 and examined rates of mortality, re-operation, and readmissions for heart failure, bleeding, and stroke.

As reported in the journal Annals of Thoracic Surgery, less than 3 percent of the patients, who had an average age of 73, died during surgery. The five-year survival rate was nearly 75 percent.

One of their most important findings was that following mitral repair, the 10-year survival rate was more than 57 percent, comparable to the average age-matched US population without heart disease.

Five years after surgery, 3.7 percent of the patients had to have another mitral valve operation; 18.4 percent experienced heart failure; 7.2 percent were readmitted for bleeding; and 7.7 percent had a stroke. Readmissions were most common in patients that presented to surgery late in their illness from mitral valve disease.

“Our data show that not only is mitral valve repair a safe option for elderly patients because of its excellent early outcomes and the low incidence of late stroke and bleeding, but it also is a well-tolerated and lasting solution for the treatment of severe heart disease,” says Badhwar, who is also co-director of the UPMC Center for Mitral Valve Disease and chief of cardiac surgery at UPMC Presbyterian hospital. “This information will improve medical guidelines to emphasize the importance of timely referral of older patients for mitral valve surgery.”

The mitral valve lies between the atria and ventricles of the heart and helps control blood flow. When it malfunctions, blood doesn’t flow the way it should, which can lead to congestive heart failure. Symptoms include shortness of breath and decreased ability to endure physical activity.

Benefits of promptly repairing the mitral valve include preservation of heart function, leading to an improved quality of life; less need for re-operation; lower operative mortality; and improved long-term survival. It also can lead to a lower likelihood of readmission for heart failure, a globally important health care issue as costs associated with readmissions continue to climb.

“The baby boomer generation will be entirely over age 65 by 2030, making it critical that we research and promote therapies that can influence long-term, hospital-free survival of older people,” Badhwar says. “Such measures will have lasting health care implications and allow hospitals to best manage their resources.”

Researchers at Duke University, University of Florida, University of Maryland, University of Michigan, Harvard University, University of Colorado, and University of South Florida College of Medicine contributed to the study, which was supported by The Society of Thoracic Surgeons Research Center through the Adult National Cardiac Database.

Source: University of Pittsburgh

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