- Email: [email protected]
Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary)
Journal Pre-proof Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary) Thomas J. O’Malley, M.D, Vakhtang Tchantchaleishvili, M.D, T. Sloane Guy, M.D., M.B.A PII:
S0003-4975(19)31375-X
DOI:
https://doi.org/10.1016/j.athoracsur.2019.07.079
Reference:
ATS 33019
To appear in:
The Annals of Thoracic Surgery
Received Date: 22 July 2019 Accepted Date: 24 July 2019
Please cite this article as: O’Malley TJ, Tchantchaleishvili V, Guy TS, Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary), The Annals of Thoracic Surgery (2019), doi: https:// doi.org/10.1016/j.athoracsur.2019.07.079. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons
Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary)
In this issue of The Annals of Thoracic Surgery, a study by Seese et al (1) reports on the outcomes of elderly patients who had undergone mitral valve surgery (MVS) at a single institution from 2010-2018 and found that 1-year and 5-year survival of mitral valve repair (MVr) and mitral valve replacement (MVR) were not significantly different. Their cohort of 472 patients underwent MVS in which 301 had MVr and 171 had MVR. Survival at 1 year was 84% for the MVr group and 86% for the MVR group and survival at 5 years was 64% for the MVr group and 64% for the MVR group, suggesting both operations provide equivalent survival benefit.
While these results are impressive, contrary to these findings, a recent systematic review and metaanalysis of 1,809 elderly patients performed by Shang et al in 2017 found a significant survival benefit to MVr over MVR. (2) They reported 1-year survival to be 84.2% for MVr and 71.0% for MVR while the 5year survival was 69.9% for MVr and 54.7% for MVR. Silaschi et al, in 2016, independently noted improved 1-year and 5-year survival for MVr (90.7% and 74.2%) when compared MVR (81.3% and 61%) suggesting MVr be the preferred approach in the elderly. (3)
Confounding the findings of Seese et al is that many of the operations performed involved concomitant procedures. When examining isolated MVR or MVr, 1-year and 5-year survival rates were similar but likely underpowered given only 37 MVR’s and 75 MVr’s were performed. The authors do note the possible type II error due to the size of the cohort. Despite these concerns, their results will contribute to the continued debate between which operation is superior in this patient population. A larger scale prospective trial performing MVS on isolated degenerative valve disease would provide the most definitive answer, though the most recent data seems to favor MVr.
1
Thomas J. O’Malley, M.D. Vakhtang Tchantchaleishvili, M.D. T. Sloane Guy, M.D., M.B.A. Division of Cardiothoracic Surgery Thomas Jefferson University 1025 Walnut St, Suite 607, Philadelphia, PA 19107 Email: [email protected]
References: 1. Seese L, Sultan I, Gleason T, Wang Y, Thoma F, Navid F, Kilic A. Outcomes of Mitral Valve Repair Versus replacement in the Elderly. Annals of Thoracic Surgery. 2019 Jul [Epub ahead of print] 2. Shang X, Lu R, Liu M, Xiao S, Dong N. Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis. J Thorac Dis. 2017;9(9):3045–3051. doi:10.21037/jtd.2017.08.43 3. Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, et al. Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short
and
Long Term Outcomes in a Propensity Matched Cohort. J Am Heart Assoc [Internet]. 2016 Aug 8;5(8).
2
S0003-4975(19)31375-X
DOI:
https://doi.org/10.1016/j.athoracsur.2019.07.079
Reference:
ATS 33019
To appear in:
The Annals of Thoracic Surgery
Received Date: 22 July 2019 Accepted Date: 24 July 2019
Please cite this article as: O’Malley TJ, Tchantchaleishvili V, Guy TS, Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary), The Annals of Thoracic Surgery (2019), doi: https:// doi.org/10.1016/j.athoracsur.2019.07.079. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2019 by The Society of Thoracic Surgeons
Outcomes of Mitral Valve Repair Versus Replacement in the Elderly (Commentary)
In this issue of The Annals of Thoracic Surgery, a study by Seese et al (1) reports on the outcomes of elderly patients who had undergone mitral valve surgery (MVS) at a single institution from 2010-2018 and found that 1-year and 5-year survival of mitral valve repair (MVr) and mitral valve replacement (MVR) were not significantly different. Their cohort of 472 patients underwent MVS in which 301 had MVr and 171 had MVR. Survival at 1 year was 84% for the MVr group and 86% for the MVR group and survival at 5 years was 64% for the MVr group and 64% for the MVR group, suggesting both operations provide equivalent survival benefit.
While these results are impressive, contrary to these findings, a recent systematic review and metaanalysis of 1,809 elderly patients performed by Shang et al in 2017 found a significant survival benefit to MVr over MVR. (2) They reported 1-year survival to be 84.2% for MVr and 71.0% for MVR while the 5year survival was 69.9% for MVr and 54.7% for MVR. Silaschi et al, in 2016, independently noted improved 1-year and 5-year survival for MVr (90.7% and 74.2%) when compared MVR (81.3% and 61%) suggesting MVr be the preferred approach in the elderly. (3)
Confounding the findings of Seese et al is that many of the operations performed involved concomitant procedures. When examining isolated MVR or MVr, 1-year and 5-year survival rates were similar but likely underpowered given only 37 MVR’s and 75 MVr’s were performed. The authors do note the possible type II error due to the size of the cohort. Despite these concerns, their results will contribute to the continued debate between which operation is superior in this patient population. A larger scale prospective trial performing MVS on isolated degenerative valve disease would provide the most definitive answer, though the most recent data seems to favor MVr.
1
Thomas J. O’Malley, M.D. Vakhtang Tchantchaleishvili, M.D. T. Sloane Guy, M.D., M.B.A. Division of Cardiothoracic Surgery Thomas Jefferson University 1025 Walnut St, Suite 607, Philadelphia, PA 19107 Email: [email protected]
References: 1. Seese L, Sultan I, Gleason T, Wang Y, Thoma F, Navid F, Kilic A. Outcomes of Mitral Valve Repair Versus replacement in the Elderly. Annals of Thoracic Surgery. 2019 Jul [Epub ahead of print] 2. Shang X, Lu R, Liu M, Xiao S, Dong N. Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis. J Thorac Dis. 2017;9(9):3045–3051. doi:10.21037/jtd.2017.08.43 3. Silaschi M, Chaubey S, Aldalati O, Khan H, Uzzaman MM, Singh M, et al. Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short
and
Long Term Outcomes in a Propensity Matched Cohort. J Am Heart Assoc [Internet]. 2016 Aug 8;5(8).
2