Elderly patients benefit from minimally invasive mitral valve surgery: perioperative risk management matters.

Autor:	Cocchieri R; Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands., Mousavi I; Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands., Verbeek EC; Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands., Riezebos RK; Department of Cardiology, OLVG, Amsterdam, the Netherlands., Yazdanbakhsh AP; Department of Cardiothoracic Surgery, OLVG, Amsterdam, the Netherlands., de Mol BAMJ; Department of Cardiothoracic Surgery, AUMC, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Interdisciplinary cardiovascular and thoracic surgery [Interdiscip Cardiovasc Thorac Surg] 2024 Jan 02; Vol. 38 (1).
DOI:	10.1093/icvts/ivad211
Abstrakt:	Objectives: The goal was to assess the single-centre results of minimally invasive mitral valve surgery (MIMVS) in the elderly population. Methods: All patients referred for minimally invasive valve surgery underwent a standardized preoperative screening. We performed a retrospective analysis of 131 consecutive elderly patients (≥75 years) who underwent endoscopic MIMVS through a right mini-thoracotomy. Survival and postoperative course were assessed in 2 groups: a repair group and a replacement group. Results: Eighty-five patients underwent mitral valve repair, and 46 had mitral valve replacement. The mean age was 79 ± 2.9 years, and the median follow-up duration was 3.8 years. The cardiopulmonary bypass time (128.7 min vs 155.9 min, P = 0.012) and the cross-clamp time (84.9 min vs 124.1 min, P = 0.005) were significantly longer in the replacement group. Except for more reinterventions for bleeding in the replacement group (10.9% vs 0%, P = 0.005), there were no significant differences in the postoperative course between the 2 groups. Low mortality rates at the midterm follow-up were observed in both groups, and no differences were observed between the 4-and the 12-month follow-up. Survival rates after 1 year and 5 years were 97.6% and 88.6%, respectively, with no significant differences between the 2 groups. Conclusions: MIMVS is an excellent treatment option in vulnerable elderly patients with excellent short- and long-term results. Although other studies suggest that repair could be superior to replacement even in older patients, our experience suggests that replacement is equivalent to repair in terms of mortality and major adverse cardiac and cerebrovascular events. Experience and standardized preoperative screening are mandatory to achieve optimal results. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)
Databáze:	MEDLINE
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