Pushing the Age Limit: Mitral Valve Surgery Is Safe and Effective in Octogenarians

This retrospective study evaluated surgical mitral valve interventions in 221 octogenarians (median age 82) at a high-volume center, addressing concerns regarding procedural risk in the elderly. The cohort achieved an overall operative mortality of 5 percent, consistent with the mean Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) of 5 percent. Notably, outcomes were superior for those undergoing mitral valve repair compared to replacement (3 percent vs. 11 percent mortality, p=0.04). Among the 168 patients with degenerative mitral regurgitation, the repair rate was 84 percent, with a 1.2 percent operative mortality, significantly outperforming the 4.3 percent baseline PROM. Mitral repair was also linked to reduced major morbidity, shorter hospital stays, higher rates of direct home discharge (p=0.001), and improved mid-term survival (p=0.02). The authors conclude that advanced age alone should not preclude conventional surgery, positioning repair as a safe, durable first-line therapy for appropriately selected octogenarians.