Outcomes Of Mitral Valve Repair Versus Replacement In The Elderly

BackgroundWith the increasing trend of the aging of China's population,it is estimated that the number of elderly population(age?75 years)will be more than doubled in the next 50 years.Recent epidemiological data show that mitral valve disease increases with age.Therefore,the proportion of elderly patients in cardiac surgery is increasing[1].Elderly patients have higher surgical difficulty,postoperative complications,and perioperative mortality due to their older age,poor tolerance,complex illness,longer duration,high calcification rate of tissue,and other chronic underlying diseases.Mitral valve disease is a common and complicated valvular disease in elderly patients with heart disease.The conservative treatment of drugs has limited efficacy.At present,surgery is the best choice for treating mitral valve disease.Mitral valve formation and replacement are also mitral.The most common surgical procedure for flap surgery.Due to concerns about higher surgical risks,elderly patients rarely undergo mitral valve surgery[2,3].Therefore,whether to adopt surgical treatment and choose which operation method can improve the clinical symptoms caused by mitral valve disease in elderly patients,reduce the incidence and mortality of postoperative complications in elderly valve patients,and benefit elderly patients,which has become an important subject of valve surgery.ObjectiveTo retrospectively study the clinical effects of mitral angioplasty and replacement in the surgical treatment of mitral valve disease in elderly patients,and to analyze the feasibility and long-term prognosis of surgical treatment of mitral valve disease in elderly patients.The experience of mitral valve surgery hopes to provide an objective reference for the safety of mitral valve disease surgery and the choice of surgical methods in elderly patients in the future.MethodsA retrospective study of elderly patients(age ? 75)who underwent cardiac surgery and mitral valve surgery in the First Affiliated Hospital of Zhengzhou University from June 2014 to June 2019.Patient age,gender,height,weight,previous history were collected.Combined with basic disease,treatment method,etiology and reflux degree of mitral valve disease,they were divided into two groups according to different mitral valve surgery methods,namely,mitral valve forming group and mitral valve replacement group.Complications(postoperative mortality,blood product input,mechanical ventilation>24 hours,acute renal failure,sepsis,pneumonia,stroke,reoperation,new-onset atrial fibrillation),readmission rate,and the effect of patients' long-term survival.ResultsMitral valve surgery was performed in 210 elderly patients,including 120 patients in the mitral valve replacement group and 90 in the mitral angioplasty group.The main cause of mitral valve disease was degenerative mitral valve disease,accounting for about 70.48%of all patients.Compared with the mitral angioplasty group,the mitral valve replacement group has more elderly women.It has a history of coronary bypass surgery,a longer period of ischemia during operation,a greater degree of mitral regurgitation,and a combination of other For cardiac surgery(coronary bypass,tricuspid valve surgery,radiofrequency ablation),the differences were statistically significant(P<0.05).Postoperative complications such as surgical mortality(in-hospital death and death within 30 days after surgery),postoperative mechanical ventilation(>24 hours),acute renal failure,sepsis,pneumonia,stroke,reoperation,and new AF There was no significant difference between the mitral angioplasty group and the mitral valve replacement group(P>0.05).Older patients with mitral valve replacement received more blood products after surgery(P<0.05).The incidence was high(P<0.05).There was no significant difference in long-term survival rates between the mitral angioplasty group and the mitral valve replacement group in elderly patients at 1 and 4 years.ConclusionsMitral valve surgery is safe and feasible for mitral valve disease in elderly patients,and its 4-year survival rate is about 70%,the complication rate of mitral angioplasty and replacement surgery in elderly patients is about the same,and the long-term survival rate is similar.However,patients with mitral valve replacement have a relatively large number of blood transfusion products during the perioperative period,and the risk of readmission after surgery is higher.