Outcome of minimal access mitral valve surgery in elderly patients

Sanjay Kumar, David Yuh

Heart India 2017 5(3):111-115

Background: Mitral valve surgery (MVS) approached through sternotomy can be associated with significant morbidity and mortality in the elderly population. The aim of this study was to review our experience with minimal access MVS (mini-mitral) in patients aged 70 years or older. Materials and Methods: A total of 44 patients over the age of 70 years had sternal sparing mini-mitral surgery performed by a single surgeon from January 2011 to November 2015. Results: A total of 44 patients (28 [64%] males and 16 [36%] females), in the age group ranging from 70 to 92 years (mean 79.84 ± 6.52), were included in the study. Comorbidities included hypertension (70.5%; n = 31), peripheral vascular disease (9.1%; n = 4), cerebrovascular disease (11.4%; n = 5), severe chronic obstructive pulmonary disease (2.3%; n = 1), and dialysis-dependent chronic kidney disease (2.3%; n = 1). Five (11.4%) patients had undergone one or more previous cardiac surgery procedures. A total of 33 (75%) patients underwent mitral valve repair, and 11 (25%) underwent replacement with bioprosthesis. Seven (15.9%) required concomitant tricuspid repair and 1 (2.3%) patent foramen ovale closure. Indications for MVS included myxomatous valve (84%; n = 37), ischemic mitral regurgitation (9%; n = 4), and infective endocarditis (7%; n = 3). Eight (18.2%) cases were performed urgently whereas 36 (71.2%) were performed on an elective basis. The median duration of cardiopulmonary bypass and cross-clamp time was 129 and 85 min, respectively. Three (6.8%) had surgery under hypothermic fibrillatory arrest. There were no conversions to median sternotomy and no 30-day mortalities. Postoperative complications included respiratory complications (34%; n = 15), stroke (4.5%; n = 2), acute renal failure (2.3%; n = 1), and reoperation for bleeding (2.3%; n = 1). The median number of hours on mechanical ventilation and hospital stay was 14 h and 7.5 days, respectively. Conclusion: Mini-mitral surgery is safe and feasible with excellent outcomes in the elderly. In our practice, it is the treatment of choice for MVS in elderly patients over the age of 70 years.

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