Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation.

OBJECTIVE

Mitral valve surgery for organic mitral regurgitation (MR) in the elderly has been debated. In the elderly, quality of life is a better indicator of surgical success than survival. We assessed quality of life of elderly patients submitted to surgery for MR using the Minnesota Living with Heart Failure (MLHF) questionnaire.

METHODS

Between August 2003 and August 2006, 225 consecutive patients >70 years old underwent surgical treatment of organic MR. Mean age was 77 +/- 3.3 years (range 71-87 years). Mean EF was 50 +/- 11%. Degenerative disease was the most prevalent (77%) etiology. CABG was associated in 25% of patients. Mean Charlson score was 4.3 +/- 1.5 and 101 patients (45%) were NYHA class III and IV. Hospital survivors were followed up and quality of life by MLHF score was assessed.

RESULTS

Mitral repair and replacement were equally distributed in this population. Hospital mortality was 2.7%. Late survival was 91 +/- 1.9% at 3 years. MLHF was obtained from 204 patients at mean 2 +/- 1 years of follow-up. MLHF score was 38 +/- 18; there were 135 (66%) patients with MLHF >30. MLHF tended to increase with age at follow-up (p = 0.007). Multivariable predictors of MLHF were preoperative atrial fibrillation (p = 0.019), diabetes (p = 0.03), higher creatinine level (p = 0.0009), higher EuroSCORE (p = 0.02), residual mitral regurgitation grade at follow-up echocardiography (p < 0.0001) and systolic pulmonary artery pressure at follow-up (p = 0.04). Type of surgical treatment (repair vs replacement and choice of prosthesis) did not predict MLHF at follow-up, although those who had recurrent MR after repair had the highest scores compared to patients who had repair and durable result and those treated by replacement (MLHF was 51 +/- 21, vs 34 +/- 16, vs 39 +/- 18, respectively, p = 0.0013).

CONCLUSIONS

Quality of life following mitral valve surgery is suboptimal in more than half of elderly patients. MLHF score at follow-up is mostly related to preoperative conditions. Type of surgery does not influence MLHF score, however, quality of life is worse in patients with recurrent/residual MR following repair.