| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Ann Thorac Surg 2004;78:813-814
© 2004 The Society of Thoracic Surgeons
Cardiothoracic Centre, Guy's and St. Thomas' Hospital, Lambeth Palace Road London, SE1 7EH UK
chris{at}blauth.com
Surgery of the mitral valve has a long history. We have learned how to replace the diseased valve and how to repair it, particularly for degenerative regurgitation, which now dominates clinical practice in most parts of the world, and is the subject of this study by Dr DiGregorio and colleagues. We already know that repair whenever possible confers numerous benefits including lower operative mortality, a lower rate of thromboembolism, freedom from anticoagulation and its attendant risks, and excellent long-term survival and freedom from reoperation. We know that annuloplasty can be simplified to the posterior annulus alone without disadvantage. Allied to technical developments has been the realization that earlier surgery improves longer term patient survival, particularly if repair is feasible.
Increased tissue fragility makes mitral repair less predictable and potentially more complex in older patients, especially if calcification is present. Older age also remains one of the most potent determinants of operative mortality in all operative risk stratification models. For these reasons not all referring physicians are convinced of the benefits of mitral surgery in this age group.
The best defense against such skepticism is good clinical data from a leading center, and all mitral repair enthusiasts will welcome this paper by Dr DiGregorio and his colleagues from the Mayo Clinic. These authors are to be congratulated not only for their excellent results but primarily for providing us with a much needed evidence base for mitral surgery in the more than 80s. Their findings of a 5-year postoperative survival identical to a normal age matched population, together with substantial improvement in New York Heart Association functional class, are compelling. It is notable that these results were achieved with a strategy of repair when feasible and despite a primary replacement rate of more than 20%. The high proportion of complex repairs and overall repair rate of nearly 80% in patients of this age should inspire all cardiac surgeons to repair more valves. This timely report also encourages us to operate with greater confidence at the upper extremes of age and to impress our cardiologists with the benefits of doing so.
Related Article
Ann. Thorac. Surg. 2004 78: 807-813.
This article has been cited by other articles:
|
|
 |
|
  D. Detaint, T. M. Sundt, V. T. Nkomo, C. G. Scott, A. J. Tajik, H. V. Schaff, and M. Enriquez-Sarano Surgical Correction of Mitral Regurgitation in the Elderly: Outcomes and Recent Improvements Circulation, July 25, 2006; 114(4): 265 - 272. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
