Our Summary

This research paper investigates whether repairing or replacing the mitral valve (a valve in the heart that prevents blood from flowing back into the heart) is more beneficial for elderly patients. The research used data from a large database of adult cardiac surgeries.

The researchers found that in patients aged 70 and above, repairing the mitral valve was linked to lower death rates after surgery compared to replacing the valve, regardless of whether the “chordae tendineae” (heart strings attached to the valve) were fully or partially preserved. However, if the repair failed, this advantage was lost.

In simple terms, for older patients with heart valve disease, repairing the valve was generally safer than replacing it. But, if the repair didn’t work, the risks were similar to replacing the valve.

FAQs

  1. What is the difference in outcome between repairing and replacing the mitral valve in elderly patients?
  2. What happens if the mitral valve repair fails in elderly patients?
  3. Does the condition of the “chordae tendineae” affect the success of a mitral valve repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about mitral valve repair is to follow post-operative care instructions carefully and attend all follow-up appointments to ensure the repair is successful and complications are minimized. It is also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support overall heart health and the success of the mitral valve repair.

Suitable For

Overall, patients who are typically recommended mitral valve repair are those who are older, have heart valve disease, and have a higher risk of complications from surgery. Repairing the mitral valve may be considered for patients who are at a higher risk for complications from valve replacement surgery, such as elderly patients or those with other underlying health conditions. Additionally, patients with specific types of mitral valve disease, such as mitral regurgitation, may benefit from valve repair rather than replacement. Ultimately, the decision to recommend mitral valve repair will depend on the individual patient’s specific circumstances and the expertise of the cardiac surgeon.

Timeline

Before mitral valve repair:

  1. Patient experiences symptoms such as shortness of breath, fatigue, chest pain, and irregular heartbeat.
  2. Patient undergoes diagnostic tests such as echocardiogram, electrocardiogram, and possibly a cardiac catheterization to determine the severity of the mitral valve disease.
  3. Patient consults with a cardiac surgeon to discuss treatment options, including mitral valve repair or replacement.
  4. Patient undergoes pre-operative testing and preparation for surgery.

After mitral valve repair:

  1. Patient undergoes mitral valve repair surgery, which involves repairing the damaged valve using various techniques such as ring annuloplasty or leaflet repair.
  2. Patient is monitored closely in the intensive care unit immediately after surgery.
  3. Patient undergoes post-operative rehabilitation and recovery, which may include physical therapy to regain strength and endurance.
  4. Patient follows up with their cardiac surgeon for regular check-ups and monitoring of the repaired valve.
  5. Patient experiences improved symptoms such as reduced shortness of breath, fatigue, and chest pain, and overall improved quality of life.

What to Ask Your Doctor

  1. What are the risks and benefits of mitral valve repair compared to mitral valve replacement?
  2. How likely is it that the mitral valve repair will be successful in my case?
  3. What are the potential complications of mitral valve repair surgery?
  4. How long is the recovery process for mitral valve repair surgery?
  5. Will I need to take medication or have follow-up procedures after mitral valve repair surgery?
  6. How will mitral valve repair surgery impact my overall heart health and quality of life?
  7. Are there any lifestyle changes I should make before or after mitral valve repair surgery?
  8. Are there any alternative treatment options to consider besides mitral valve repair?
  9. How experienced is the surgical team in performing mitral valve repair procedures?
  10. What should I expect in terms of long-term outcomes and prognosis after mitral valve repair surgery?

Reference

Authors: Hendrix RJ, Bello RA, Flahive JM, Kakouros N, Aurigemma GP, Keaney JF, Hoffman W, Vassileva CM. Journal: Ann Thorac Surg. 2019 Mar;107(3):747-753. doi: 10.1016/j.athoracsur.2018.09.018. Epub 2018 Oct 26. PMID: 30612990