초록접수 현황
| 15F-239 | 포럼 발표 |
Clinical Outcome Comparison between Mitral Valve Repair and Replacement for Mitral Regurgitation in Patients over 70 years of age
Shin-Young Lee, Seung Hyun Lee, Hyun-Chel Choo, Sak Lee, Byung- Chul Chang, Kyung-Jong Yoo, Young-Nam Youn
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Background : Mitral valve repair for elderly patients is reluctantly decided despite the superiority of repair in younger patients due to co-morbidities and the high risk associated with re-operation. The objective of this study is to compare mitral valve repair with replacement in elderly patients (age 70≤)
Methods : From our institution, total of 108 patients (age 70≤) underwent either mitral valve repair or replacement (tissue valve) from 1995 to 2015. The primary endpoint was mortality and secondary endpoint was postoperative major complications (cerebrovascular events, renal failure, reoperation for bleeding control, replacement conversion, residual mitral regurgitation or recurred mitral regurgitation). The clinical outcomes were compared using Kaplan-Meier analysis. The mean follow-up was 4.8±4.4 years
Results : The 71 patients (mean age: 72.49±1.10 years) underwent mitral valve repair (MVP group) and 37 patients (mean age: 74.10±0.54 years) underwent mitral tissue valve replacement (MVR group). Preoperative co-morbidities, such as hypertension, diabetes mellitus, cerebrovascular events, coronary artery disease, NYHA class (3 or 4), left ventricular ejection fraction (%) were compared between two groups and showed no statistically significant differences. The etiologies of mitral valve disease were rheumatic in 14 patients (MVP group vs. MVR group: 2 vs.12), degenerative in 85 patients (MVP group vs. MVR group: 63 vs.22). Incidences of postoperative major complications, such as stroke, renal failure, and reoperation for bleeding control, were higher in the replacement group (MVP vs. MVR: n=21, 30.9% vs. n=15, 37.5%, p=0.53). In MVP group, post-operative residual MR (n=15, 13.9%), conversion to replacement case (n=4, 3.7%), and recurred MR (n=1, 0.9%) occurred. In-hospital mortality were similar (MVP vs. MVR: n=5, 4.6% vs. n=2, 1.9%, p=1.0), and hospital stay (MVP vs. MVR:17 days vs. 25.5 days, p=0.13). Overall survival rates at 1, 3, and 5 year showed no significant differences between group (MVP vs. MVR: 89% vs. 95%, 86% vs. 91%, 81% vs. 82%, p=0.36)
Conclusion : There are no significant differences between mitral repair and replacement in postoperative major complications, in-hospital and overall mortality. Mitral valve repair, which is more favorable to natural physiology, should be considered for elderly patients with severe mitral regurgitation.
Methods : From our institution, total of 108 patients (age 70≤) underwent either mitral valve repair or replacement (tissue valve) from 1995 to 2015. The primary endpoint was mortality and secondary endpoint was postoperative major complications (cerebrovascular events, renal failure, reoperation for bleeding control, replacement conversion, residual mitral regurgitation or recurred mitral regurgitation). The clinical outcomes were compared using Kaplan-Meier analysis. The mean follow-up was 4.8±4.4 years
Results : The 71 patients (mean age: 72.49±1.10 years) underwent mitral valve repair (MVP group) and 37 patients (mean age: 74.10±0.54 years) underwent mitral tissue valve replacement (MVR group). Preoperative co-morbidities, such as hypertension, diabetes mellitus, cerebrovascular events, coronary artery disease, NYHA class (3 or 4), left ventricular ejection fraction (%) were compared between two groups and showed no statistically significant differences. The etiologies of mitral valve disease were rheumatic in 14 patients (MVP group vs. MVR group: 2 vs.12), degenerative in 85 patients (MVP group vs. MVR group: 63 vs.22). Incidences of postoperative major complications, such as stroke, renal failure, and reoperation for bleeding control, were higher in the replacement group (MVP vs. MVR: n=21, 30.9% vs. n=15, 37.5%, p=0.53). In MVP group, post-operative residual MR (n=15, 13.9%), conversion to replacement case (n=4, 3.7%), and recurred MR (n=1, 0.9%) occurred. In-hospital mortality were similar (MVP vs. MVR: n=5, 4.6% vs. n=2, 1.9%, p=1.0), and hospital stay (MVP vs. MVR:17 days vs. 25.5 days, p=0.13). Overall survival rates at 1, 3, and 5 year showed no significant differences between group (MVP vs. MVR: 89% vs. 95%, 86% vs. 91%, 81% vs. 82%, p=0.36)
Conclusion : There are no significant differences between mitral repair and replacement in postoperative major complications, in-hospital and overall mortality. Mitral valve repair, which is more favorable to natural physiology, should be considered for elderly patients with severe mitral regurgitation.
책임저자: Young-Nam Youn
Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
연락처 : Shin-Young Lee, Tel: 02-2227-2521 , E-mail : yonseimed@gmail.com
