Early Outcome of Endoscopic Mitral Valve Surgery in Elderly Patients: A High-Volume Single-Center Experience

Background: Despite increasing use of percutaneous, transcatheter approaches, endoscopic mitral valve surgery (MVS) remains the gold standard for treatment of mitral regurgitation. Nevertheless, as perioperative risk increases with age, outcome of MVS in elderly patients is uncertain.

Method: Between 2015 and 2021, a total of 726 consecutive patients underwent fully endoscopic MVS at our institution. Patients were treated endoscopically using a limited right-sided anterolateral skin incision and 3D-camera visualization. According to their age at the time of surgery, patients were categorized as above (elderly group; n = 80) or below (control group; n = 646) 75 years. Preoperative characteristics and periprocedural outcome were retrospectively analyzed.

Results: Within patients in the elderly group (e.g., median age of 78.0 [76–80] years vs. 59.5 [52–66] years in the control group; p < 0.001), the prevalence of arterial hypertension, diabetes, coronary artery disease, and atrial fibrillation (AFib) was increased (all p < 0.001). Despite a higher prevalence of NYHA class III/IV symptoms and a lower LVEF within the elderly group, preoperative serum levels of natriuretic peptide were similar between groups. The rate of mitral valve repair was 87.5% within the elderly group versus 93.2% within the control group (p = 0.067). Atrial ablation and closure of the left atrial appendage were more frequently performed within the elderly group, whereas the rate of concomitant tricuspid valve repair was similar (11.3 vs. 7.4%; p = 0.231). Axillofemoral perfusion was more frequently used within the elderly group (33.8 vs. 3.7%: p < 0.001). Conversion rates to full sternotomy were favorably low within both groups (5.0 vs. 2.2%; p = 0.126). Postoperative complications including pacemaker implantation (3.8 vs. 1.9%), occlusion of circumflex coronary artery (0 vs. 0.8%), rethoracotomy (10 vs. 8.7%), right heart failure (1.25 vs. 1.7%), and low cardiac output (5 vs. 3.4%) were favorably low within both groups. Furthermore, 30-day mortality was 1.2 versus 0.6% (p = 0.444).

Conclusion: Despite an increased prevalence of outcome-relevant comorbidities and surgical risk, perioperative outcome of patients above 75 years undergoing endoscopic MVS is favorable. Therefore, in addition to transcatheter approaches, endoscopic MVS is a valuable therapeutic option for elderly patients and should be taken in consideration during routine heart-team discussion.

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Artikel online veröffentlicht:
28. Januar 2023