Mitral valve surgery in elderly patients]

The increase in life expectancy results in a larger number of elderly patients with mitral valve pathology requiring surgical correction. Generally speaking, the indications for surgery are identical to those which apply to other age groups, but the greater incidence of mortality and, especially, of morbility make a degree of selectivity advisable. More than with any group, it is important to consider the risk: benefit ratio. However, in the majority of cases, it is possible to optimise the clinical condition of the patients with a significant decrease in risk. One of the most controversial aspects is that of the advantages or disadvantages of mitral valvuloplasty vs. prosthetic replacement. Although the eventual lower durability of the valvuloplasty might be considered a contraindication, because of the risk of reintervention at a later age, I believe that valvuloplasty is also preferable in elderly patients. This is confirmed by the well known fact that mitral valvuloplasty for myxomatous mitral regurgitation, prevailing in this age group, has the most durable results among all types of pathology. In the last 10 years, 433 patients above 70 years of age (11.6% of the total) were subjected to valvular surgery in Coimbra. Valvuloplasty was possible in more than 90% of the cases of mitral valve surgery. The mortality was only 2.6%, but significantly higher than that observed in younger patients (0.8%). In conclusion, mitral valve surgery in elderly patients is feasible with acceptable mortality and morbidity, but pre-operative optimization of the patients is essential.