Vol. 20 JA2016 - cardiac

C-13 – Long-term outcomes following mitral valve surgery in octogenarians

novembre 29, 2016
Auteur correspondant : Michel Kindo

Michel Kindo, Tam Hoang Minh, Stéphanie Perrier, Jonathan Bentz, Clément Schneider, Yi Yang, Sarra Benmouhoub, Dharmesh Ramlugun, Anna-Maria Deaconu, Marion Kibler, Alexandre Vorburger, Anne-Lorraine Bourquiaux, Arnaud Mommerot, Philippe Billaud, Jean-Philippe Mazzucotelli

Institution : Service de chirurgie cardiaque, hôpitaux universitaires de Strasbourg

Objectives : In our practice, mitral valve surgery in octogenarians is associated with satisfactory in-hospital mortality. The aims of this study were to assess mitral valve surgery in octogenarians regarding long-term survival and quality of life.

Methods : Between 2000 and 2014, 132 consecutive octogenarians (mean age of 82.7±2.4) years) underwent mitral repair (MVA n=62, 47.0%) or mitral replacement (MVR, n=70, 53.7%). One or more associated procedures were performed in 71 patients (53,0%). The study population was divided into 4 groups according to the type of mitral surgery performed: 19.7% (n=26) were in the isolated MVA group; 26.5% (n=35), in the isolated MR group; 27.3% (n=36), in the combined MVR group; and 26,5% (n=35), in the combined MVR group. The overall mean EuroSCORE II was 9.7±9.6%. Overall hospital mortality was 8.3%.

The mean follow-up was 4.1±3.3 years and 3 patients were lost during the follow-up.

Results : Overall survival rates at 1, 3 and 5 and 10 years were 86.9±3.0%, 81.9±3.5% and 74.5±4.5% respectively. Survival rates after MVA and MVR surgeries at 1, 3 and 5 years were 91.8±3.5% versus 87.0±4.1%, 83.7±5.5% versus 79.4±4.9% and 79.7±6.5% versus 69.9±6.2%; respectively (log-rank test=0.082). There was no significant difference in survival rates between the 4 groups (log-rank test=0.142). At last follow-up, most patients experienced a significant improvement of their functional status, with 89.1% in NYHA class I or II. A total of 81.6% of the patients were living at home whereas 5.9% were living in a nursing home, with altered cognitive function. Three patients (2.5%) had a permanent stroke during the follow-up. When excluding patients who died during the in-hospital period, 92.0% and 94.1% of the patients in the isolated MVA and combined MVA groups, respectively, had mitral regurgitation below grade 2.

Conclusion : In our study, mitral valve surgery in octogenarians was associated with satisfactory long-term survival and quality of life. The age of the patient and the complexity of the surgery thus should not be limiting factors for mitral surgery.