No Age Limit for Mitral Valve Repair

ROCHESTER, Minn. July 17 -- Repair of a faulty mitral valve is worth the risk regardless of patient age, even though it has been considered a perilous procedure, according to researchers here.

As surgical techniques have improved in recent years mortality has declined for patients of all ages, Delphine Detaint, M.D., and Mayo Clinic colleagues wrote in a study released online today by Circulation, Journal of the American Heart Association.

Compared with younger patients, those ages 75 or older "showed no difference in life expectancy restoration."

Operative mortality among patients 75 or older declined form 27% in 1980 to just 5% in 1995 (P<0.01) and from 21% to 4% for those ages 65 to 74 (P<0.01). For patients younger than 65 the mortality declined from 6% to 2%, but that change was not statistically significant.

"Over time, valve repair feasibility increases in all age groups (30% to 84% overall and 31% to 93% for patients with degenerative [mitral regurgitation]; P<0.0001)," the authors wrote.

Dr. Detaint and colleagues analyzed data from 1,344 patients, mean age 65. The patients, 61% men, all had surgical repair of mitral valve regurgitation. Two hundred and eighty-four patients were 75 or older, 504 were 65 to 74, and 556 were younger than 65.

Eight hundred and fifty-six patients had degenerative mitral regurgitation and 488 had nondegenerative disease.

Fifty seven percent of patients 75 or older at the time of surgery survived for at least five years as did 73% of those ages 65 to 74 and 85% of patients 64 or younger.

As might be expected, the older patients tended to be sicker than younger patients, with more congestive heart failure, atrial fibrillation, and in need of bypass surgery as well as valve repair (P<0.002 for all compared with younger patients). And as patient age increased, the prospect of survival decreased so that age 75 or older "was independently predictive of lower survival (risk ratio, 1.05[95% CI 1.04 to 1.06] per year of increasing age; P<0.001)," the authors wrote.

The authors noted that the study was limited by its retrospective nature and by its inclusion of only patients who underwent surgical repair; a sample that they cautioned might not "represent all elderly patients with [mitral regurgitation]." Moreover, the true benefit of surgery "cannot be defined without a randomized clinical trial."

Nonetheless, they concluded that on the basis of the available data "surgery should not be denied on the basis of age alone and, in carefully selected elderly patients, should be offered before the occurrence of refractory heart failure"