Age No Barrier to Heart Valve Surgery

New findings show the procedure is now much safer for elderly patients

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By Steven Reinberg
HealthDay Reporter

MONDAY, July 17, 2006 (HealthDay News) -- Older patients who have surgery for a leaky mitral heart valve can now regain their normal life expectancy and improve their quality of life without a high risk of complications, Mayo Clinic researchers report.

"In view of these improved results, we should be more aggressive and operate on patients whose conditions are not so advanced so that we can offer them the improvements related to surgery," said lead author Dr. Maurice E. Sarano, a professor of medicine at the Mayo Clinic in Rochester, Minn.

The report is in the July 25 issue of Circulation.

The mitral valve regulates blood flow from the heart's left atrium to its left ventricle. A leaking mitral valve causes blood to flow back from the lower to the upper chamber, a defect called mitral regurgitation. This abnormal flow can cause breathing problems, fatigue, irregular heartbeats and potentially fatal congestive heart failure.

Surgeons have typically been reluctant to repair or replace a leaking mitral valve in patients over 75, because the procedure has had a high death rate and poor long-term survival in this age group.

However, the new study finds that for the over-75 group, the death rate for mitral valve surgery has dropped dramatically -- from 27 percent in 1980 to just 5 percent by 1995.

Traditionally, "cardiac surgery in the elderly has a bad reputation," Sarano said. "Because the risk is said to be high and the outcomes are not so good, [and] because people don't live that long."

However, recent improvements in surgery have changed this picture, Sarano said. "We restore life expectancy in the old patients as well as in young patients," he said. "There was also a decrease in mortality and morbidity from the surgery. But what is most remarkable is that the improvement was most pronounced in the older patients."

In their study, Sarano's group reviewed the records of 1,344 patients who had mitral valve surgery at the Mayo Clinic between January 1, 1980, and December 31, 1995. The patients were placed into three groups, based on their age at surgery: 75 and older, 65 to 74 and younger than 65.

They found that for all ages, death from mitral valve surgery dropped from 16 percent to 3 percent overall. In addition, five-year survival adjusted for life expectancy was 91 percent for the oldest patients, 98 percent for the intermediate age group, and 97 percent for the youngest patients.

Moreover, the feasibility of successful mitral valve surgery among these patients improved from 30 percent in 1980-1983 to 84 percent in 1992-1995. But, most important, the surgery was associated with a restoration of life expectancy for elderly patients that nearly equaled that seen in patients younger than age 75.

Sarano believes that, based on these findings, age should be no impediment to mitral valve surgery. "Don't be stopped by age," he said.

One expert agreed. "Elderly patients should not let age be a barrier to getting treatment for mitral valve prolapse," said Dr. Eugene A. Grossi, a professor of cardiothoracic surgery at New York University School of Medicine and director of NYU's cardiac surgery research. "Patients should have the operation before co-morbidities like heart failure develop."

Grossi noted that he is seeing more elderly patients and expects the trend to continue as the population ages. In addition, his study of 700 elderly patients undergoing a similar procedure, called aortic valve surgery, turned up similar results.

According to Grossi, patients in their 80s and even in their 90s can have good outcomes and resume an active lifestyle. "The point of doing the surgery is not to extend life, but to restore quality of life," he said.

Another expert thinks that older patients who need the surgery should consider it because of the better outcomes seen now.

"It goes against the frequent belief that older patients have less to gain from an invasive procedure," said Dr. Byron K. Lee, an assistant professor of cardiology at the University of California, San Francisco. "In this study, life expectancy following valve surgery is shorter for the elderly, which is expected. The elderly are more likely to die of other diseases than younger patients," Lee said.

However, the study indicates that the elderly are just as likely as younger patients to return to the same life expectancy as their peers, Lee added. "Perhaps, that is important for patients to consider when deciding on surgery. They are just as likely as younger patients to get back to living as their friends in their same age group."

More information

For more on mitral valve surgery, head to the Society of Thoracic Surgeons.

SOURCES: Maurice E. Sarano, M.D., professor, medicine, Mayo Clinic, Rochester, Minn.; Eugene A. Grossi, M.D., professor, cardiothoracic surgery, New York University School of Medicine, director, Cardiac Surgery Research, New York City; Byron K. Lee M.D., assistant professor, cardiology, University of California, San Francisco; July 25, 2006, Circulation: Journal of the American Heart Association

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