Mitral Valve Repair vs. Replacement in Elderly Patients: Benefits and Outcomes

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• Mitral Valve Repair Benefits Over Replacement
• Excellent Outcomes for Elderly Patients
• Hybrid Surgery for Valve and Artery Disease
• Minimally Invasive Surgical Techniques
• Long-Term Survival Data Favors Repair
• The Importance of a Second Opinion

Mitral Valve Repair Benefits Over Replacement

Mitral valve repair offers significant physiological advantages compared to mitral valve replacement. Dr. Lawrence Cohn, MD, emphasizes that a repaired mitral valve functions more naturally. This is because the valve's chords remain attached to the papillary muscles within the heart. This preservation of the heart's natural anatomy leads to better overall ventricular heart function.

The procedure is considered a more physiologic solution for mitral valve prolapse. Dr. Anton Titov, MD, discusses the clinical dilemma surgeons and patients face, with the evidence strongly favoring repair. This superior functionality is a key reason leading cardiac surgeons now prefer repair over replacement whenever possible.

Excellent Outcomes for Elderly Patients

Mitral valve repair delivers excellent clinical results even in advanced age groups. Dr. Lawrence Cohn, MD, states that outcomes for patients over 70 or even over 80 years of age are very good. This has led to a shift in practice, with more elderly patients being accepted for this life-enhancing heart valve surgery.

Traditionally, mitral valve replacement was the standard procedure. However, surgical advancements and proven results now make repair the preferred option. The interview with Dr. Anton Titov, MD, highlights that age alone is not a barrier to receiving the most beneficial surgical treatment for mitral valve disease.

Hybrid Surgery for Valve and Artery Disease

Hybrid heart surgery is an innovative method for patients with both valve and coronary artery disease. Dr. Lawrence Cohn, MD, a pioneer in this technique, explains the process. A patient can receive coronary artery stents in the morning to address blockages. Then, on the same day, they undergo minimally invasive mitral valve repair surgery.

This approach, often performed in a dedicated hybrid operating room, combines the expertise of interventional radiology and cardiac surgery. Dr. Lawrence Cohn, MD, recounts the story of the first patient who proposed this idea, which has since become a standard treatment pathway in many top US hospitals.

Minimally Invasive Surgical Techniques

Minimally invasive techniques are now routinely applied in heart valve surgery for elderly patients. These approaches involve smaller incisions, which can lead to reduced pain and faster recovery times. Dr. Lawrence Cohn, MD, confirms that surgeons successfully use these methods even in octogenarians.

The development of hybrid operating rooms has been crucial for advancing minimally invasive cardiac procedures. Dr. Anton Titov, MD, explores how this technology allows for a seamless transition from a stent placement to a valve operation, all within one specialized suite, maximizing patient safety and efficiency.

Long-Term Survival Data Favors Repair

Long-term survival data consistently shows better results after mitral valve repair than after replacement. Dr. Lawrence Cohn, MD, stresses that this survival benefit holds true across any age group. This compelling data is the fundamental reason cardiac surgeons advocate so strongly for repair.

The improved longevity is directly linked to the procedure's physiologic nature. By preserving the native valve apparatus and ventricular function, repair mitigates long-term complications associated prosthetic valves. This makes it an especially good surgical strategy for elderly patients seeking durable outcomes.

The Importance of a Second Opinion

Seeking a second opinion is a critical step for patients diagnosed with mitral valve prolapse. A second opinion confirms the initial diagnosis is correct and complete. It also ensures that a patient is presented with all available treatment options, including the possibility of mitral valve repair.

Dr. Anton Titov, MD, discusses how this process helps patients choose the best treatment with confidence. Consulting with a specialized cardiac surgeon like Dr. Lawrence Cohn, MD, can provide clarity on complex decisions, such as whether a repair is feasible and which surgical approach—traditional or hybrid—is most appropriate.

Full Transcript

Dr. Anton Titov, MD: Which method of mitral valve prolapse surgical treatment is better? Mitral valve repair or heart valve replacement in elderly patients?

Dr. Lawrence Cohn, MD: It is a frequent dilemma for a patient and surgeon. Mitral valve repair is more natural than mitral valve replacement. Comparison of clinical outcomes favors mitral valve repair. It is better than mitral valve replacement.

Results in patients over 70 or even over 80 years of age is very good. Mitral valve repair also can be combined with angioplasty. This is called hybrid surgery.

More elderly patients over 70 years of age are now being accepted for heart valve surgery. Traditionally surgeons performed mitral valve replacement, but now they prefer mitral valve repair.

Dr. Anton Titov, MD: What are the advantages of repair of mitral valve? Is it better than a replacement of mitral valve?

Dr. Lawrence Cohn, MD: Mitral valve repair is much more physiologic. Sometimes surgeons repair the mitral valve. Mitral valve works as it should. Mitral valve chords are still attached to papillary muscles. Ventricular heart function is better.

We also know that in any age group it is true. The long-term survival of patients is better after mitral valve repair than after replacement of mitral valve. That is why we think that mitral valve repair is very good thing to do in the elderly patients. It is especially good for the elderly patients.

More and more patients even after age of 80 years have mitral valve repair. Old patients have excellent clinical results. Surgeons also use minimally invasive heart valve surgery techniques in elderly patients.

Sometimes patients do not have significant coronary artery disease. There is also another way to mitral valve repair. This method treats coronary artery disease also. This is called "hybrid method". We were the first to use this "hybrid heart surgery method" treatment.

We started to perform minimally invasive aortic valve surgery. Then a man came to my office. He said, "I need a new aortic valve, and I would like to have a minimally invasive aortic valve operation. But I also have a blocked coronary artery. Can we put a stent in my blocked coronary artery first? Can we then replace my aortic valve?"

I said to this man, "We can do that." This is how we started to perform hybrid heart surgeries.

Sometimes a person has one vessel or two vessel coronary artery disease. We can first put stents in patient's coronary arteries in the morning. Then in the afternoon we can bring the patient to operating room to do minimally invasive aortic valve surgery on the same day.

Now many hospitals in the United States build hybrid operating rooms. It includes this hospital. Such hybrid operating rooms allow interventional radiology specialists to perform coronary artery stent placement.

Then in the same operating room equipment is changed. Cardiac surgeons can perform minimally invasive heart valve surgery. Hybrid heart surgery is another method to treat patients. They have both coronary artery disease and heart valve problems.

Dr. Anton Titov, MD: Mitral valve repair or replacement? Mitral valve repair is more physiologic than heart valve replacement. Hybrid surgery is possible: angioplasty and mitral valve repair. Mitral valve repair or replacement? Which method of mitral valve prolapse surgical treatment should patients prefer?