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Survival of Octogenarians Undergoing Concomitant Mitral Valve Surgery and Coronary Artery Bypass in Northern New England.
Bruce J Leavitt1, Cathy S Ross2, Elaine M Olmstead2, Robert A Clough3, Felix Hernandez3, John H Braxton4, David C Charlesworth5, Mitchell C Norotsky1, Gerald T O'Connor2
1University of Vermont, Burlington, VT;2Dartmouth Medical School, Hanover, NH;3Eastern Maine Medical Center, Bangor, ME;4Maine Medical Center, Portland, ME;5Catholic Medical Center, Manchester, NH
Objective: To examine the in-hospital and long-term mortality for octogenarians undergoing concomitant mitral valve (MV) replacement or repair with coronary artery bypass grafting (CABG)
Design: Retrospective, observational study of octogenarians undergoing MV repair/replacement with CABG in the Northern New England
Setting: Regional cardiac surgery database.
Patients: 2,443 consecutive patients undergoing CABG with MV replacement/repair from 1992 through 2005, 251 (10.3%) were 80 years old or older. Long-term data was available from 1987 through 2001.
Interventions: None
Main Outcome Measures: In-hospital and long-term mortality
Results: Among patients >=80 yrs old having CABG with MV surgery, 37% (n=94) had replacement, 56% (n=140) had repair and 7%(n=17) had an attempted repair that was converted to replacement. Overall crude in-hospital mortality was 17.7% (19.1%, 17.1%, 11.8% for replacement, repair and replacement plus repair, respectively). Patients >=80 had more degenerative and less ischemic disease than younger patients. Median survival overall was 3.6 yrs, with an annual incidence rate of death of 25.2% (deaths per 100 person years). Median survival for replacement vs. repair was 3.1 vs. 3.6 years (incidence rates were 25.6% and 25.1%). After adjustment for patient and disease characteristics, there was no increased risk of death for MV replacement vs. repair (HR 0.9, 95% CI, 0.6-1.4, p<0.626).
Conclusions: Conclusive outcome data in the surgical literature on octogenarians undergoing MV surgery with concomitant CABG is quite sparse. Our study examined the in-hospital and long-term outcomes. Median survival for this group was 3.6 years. In-hospital and long-term mortality for MV replacement and MV repair did not differ. Cardiac surgeons who council octogenarians with mitral valvular and coronary artery disease can provide accurate mortality data in this group of patients.
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