Minimally invasive valve surgery: pushing boundaries over the eighty

Cristina Barbero; Dario Brenna; Antonio Salsano; Marco Pocar; Erik Cura Stura; Claudia Calia; Viviana Sebastiano; Mauro Rinaldi; Davide Ricci

doi:10.26599/1671-5411.2023.04.006

Volume 20 Issue 4

Apr. 2023

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Article Navigation > Journal of Geriatric Cardiology > 2023 > 20(4): 276-283

Please cite this article as: Barbero C, Brenna D, Salsano A, Pocar M, Stura EC, Calia C, Sebastiano V, Rinaldi M, Ricci D. Minimally invasive valve surgery: pushing boundaries over the eighty. J Geriatr Cardiol 2023; 20(4): 276−283. DOI: 10.26599/1671-5411.2023.04.006

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Please cite this article as: Barbero C, Brenna D, Salsano A, Pocar M, Stura EC, Calia C, Sebastiano V, Rinaldi M, Ricci D. Minimally invasive valve surgery: pushing boundaries over the eighty. J Geriatr Cardiol 2023; 20(4): 276−283. DOI: 10.26599/1671-5411.2023.04.006

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Minimally invasive valve surgery: pushing boundaries over the eighty

doi: 10.26599/1671-5411.2023.04.006

1.
Department of Cardiovascular and Thoracic Surgery, Città della Salute e della Scienza, University of Turin, Turin, Italy
2.
Department of Integrated Surgical and Diagnostic Sciences, University of Genoa, Genoa, Italy
3.
Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

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Corresponding author: cristina.barbero@unito.it
Available Online: 2023-05-08
Publish Date: 2023-04-28

Abstract

Abstract

BACKGROUND Mean age of patients with valves diseases is significantly increasing, and, in the near future, cardiac surgeons will have to deal with a considerable number of patients aged more than 80 years. The remarkable results gained by the minimally invasive approach have encouraged its application in more complex and fragile patients, such as older people. This study aimed to identify the rate of early mortality and major complications, and independent predictors for mid-term mortality in octogenarians undergoing minimally invasive valve surgery. METHODS Octogenarian patients undergoing right mini-thoracotomy mitral and/or tricuspid valve surgery between 2006 and 2020 were included. Primary endpoint was to identify independent predictors for mid-term mortality, and secondary endpoints were operative morality, stroke, independent predictors for early composite outcome, and quality of life at follow-up. RESULTS Analysis was performed on 130 patients. Stroke occurred in one patient (0.8%), while operative mortality was 6% (eight patients). One-year and five-year survival were 86% and 64%, respectively. Logistic regression identified age and creatinine level as independent predictors of mid-term mortality, survival analysis showed that age ≥ 84 years and creatinine level ≥ 1.22 mg/dL were the cut-off points for worst prognosis. Female gender and hypertension were found to be independent predictors of early composite outcome. CONCLUSIONS Results of the present study show that age alone should not be considered a contraindication for minimally invasive valve surgery. Identifying patients who are most likely to have survival and functional benefits after surgery is decisive to achieve optimal health outcomes and prevent futile procedures.

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References(34)

References

[1]	Etzioni DA, Liu JH, Maggard MA, et al. The aging population and its impact on the surgery workforce. Ann Surg 2003; 238: 170−177. doi: 10.1097/01.SLA.0000081085.98792.3d
[2]	Falk V, Cheng DC, Martin J, et al. Minimally invasive versus open mitral valve surgery: a consensus statement of the international society of minimally invasive coronary surgery (ISMICS) 2010. Innovations (Phila) 2011; 6: 66−76. doi: 10.1097/imi.0b013e318216be5c
[3]	Casselman F, Aramendi J, Bentala M, et al. Endoaortic clamping does not increase the risk of stroke in minimal access mitral valve surgery: a multicenter experience. Ann Thorac Surg 2015; 100: 1334−1339. doi: 10.1016/j.athoracsur.2015.04.003
[4]	Barbero C, Krakor R, Bentala M, et al. Comparison of endoaortic and transthoracic aortic clamping in less-invasive mitral valve surgery. Ann Thorac Surg 2018; 105: 794−798. doi: 10.1016/j.athoracsur.2017.09.054
[5]	Collart F, Feier H, Kerbaul F, et al. Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg 2005; 27: 276−280. doi: 10.1016/j.ejcts.2004.10.041
[6]	Kolh P, Kerzmann A, Lahaye L, et al. Cardiac surgery in octogenarians; peri-operative outcome and long-term results. Eur Heart J 2001; 22: 1235−1243. doi: 10.1053/euhj.2000.2443
[7]	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: e1159−e1195. doi: 10.1161/CIR.0000000000000503
[8]	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012; 33: 2451−2496. doi: 10.1093/eurheartj/ehs109
[9]	Barbero C, Marchetto G, Ricci D, et al. Right minithoracotomy for mitral valve surgery: impact of tailored strategies on early outcome. Ann Thorac Surg 2016; 102: 1989−1994. doi: 10.1016/j.athoracsur.2016.04.104
[10]	Barbero C, Marchetto G, Ricci D, et al. Steps forward in minimally invasive cardiac surgery: 10-year experience. Ann Thorac Surg 2019; 108: 1822−1829. doi: 10.1016/j.athoracsur.2019.04.109
[11]	Katz S, Ford AB, Moskowitz RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963; 185: 914−919. doi: 10.1001/jama.1963.03060120024016
[12]	Mlinac ME, Feng MC. Assessment of activities of daily living, self-care, and independence. Arch Clin Neuropsychol 2016; 31: 506−516. doi: 10.1093/arclin/acw049
[13]	Sacanella E, Pérez-Castejón JM, Nicolás JM, et al. Functional status and quality of life 12 months after discharge from a medical ICU in healthy elderly patients: a prospective observational study. Crit Care 2011; 15: R105. doi: 10.1186/cc10121
[14]	Barbero C, Ricci D, El Qarra S, et al. Aortic cannulation system for minimally invasive mitral valve surgery. J Thorac Cardiovasc Surg 2015; 149: 1669−1672. doi: 10.1016/j.jtcvs.2015.02.040
[15]	Sansone F, Barbero C, Rinaldi M. Occlusion of both caval veins by an endovascular occluder. Heart Lung Circ 2012; 21: 275−277. doi: 10.1016/j.hlc.2012.03.003
[16]	Ogłuszka M, Orzechowska M, Jędroszka D, et al. Evaluate cutpoints: adaptable continuous data distribution system for determining survival in Kaplan-Meier estimator. Comput Methods Programs Biomed 2019; 177: 133−139. doi: 10.1016/j.cmpb.2019.05.023
[17]	Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368: 1005−1011. doi: 10.1016/S0140-6736(06)69208-8
[18]	Nishimura RA, Vahanian A, Eleid MF, et al. Mitral valve disease: current management and future challenges. Lancet 2016; 387: 1324−1334. doi: 10.1016/S0140-6736(16)00558-4
[19]	Collart F, Feier H, Kerbaul F, et al. Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg 2005; 27: 276−280. doi: 10.1016/j.ejcts.2004.10.041
[20]	Grayburn PA, Sannino A, Packer M. Proportionate and disproportionate functional mitral regurgitation: a new conceptual framework that reconciles the results of the MITRA-FR and COAPT trials. JACC Cardiovasc Imaging 2019; 12: 353−362. doi: 10.1016/j.jcmg.2018.11.006
[21]	Moscarelli M, Cerillo A, Athanasiou T, et al. Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot. Interact Cardiovasc Thorac Surg 2016; 22: 756−761. doi: 10.1093/icvts/ivw038
[22]	Seeburger J, Raschpichler M, Garbade J, et al. Minimally invasive mitral valve surgery in octogenarians: a brief report. Ann Cardiothorac Surg 2013; 2: 765−767. doi: 10.3978/j.issn.2225-319X.2013.10.13
[23]	Holzhey DM, Shi W, Borger MA, et al. Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison. Ann Thorac Surg 2011; 91: 401−405. doi: 10.1016/j.athoracsur.2010.08.006
[24]	Biancari F, Schifano P, Pighi M, et al. Pooled estimates of immediate and late outcome of mitral valve surgery in octogenarians: a meta-analysis and meta-regression. J Cardiothorac Vasc Anesth 2013; 27: 213−219. doi: 10.1053/j.jvca.2012.11.007
[25]	Rizzoli G, Bejko J, Bottio T, et al. Valve surgery in octogenarians: does it prolong life? Eur J Cardiothorac Surg 2010; 37: 1047−1055. doi: 10.1016/j.ejcts.2009.11.043
[26]	Iribarne A, Easterwood R, Russo MJ, et al. Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg 2012; 143: S86−S90. doi: 10.1016/j.jtcvs.2011.10.090
[27]	Dvir D, Webb J. Mitral valve-in-valve and valve-in-ring: technical aspects and procedural outcomes. EuroIntervention 2016; 12: Y93−Y96. doi: 10.4244/EIJV12SYA25
[28]	You T, Wang W, Yi K, et al. Transcatheter mitral valve replacement for degenerated mitral valve bioprostheses, failure of mitral valvuloplasty and native valve with severe mitral annulus calcification: a systematic review and meta-analysis. J Cardiothorac Surg 2021; 16: 293. doi: 10.1186/s13019-021-01677-7
[29]	Yoon SH, Whisenant BK, Bleiziffer S, et al. Outcomes of transcatheter mitral valve replacement for degenerated bioprostheses, failed annuloplasty rings, and mitral annular calcification. Eur Heart J 2019; 40: 441−451. doi: 10.1093/eurheartj/ehy590
[30]	Guerrero M, Vemulapalli S, Xiang Q, et al. Thirty-day outcomes of transcatheter mitral valve replacement for degenerated mitral bioprostheses (valve-in-valve), failed surgical rings (valve-in-ring), and native valve with severe mitral annular calcification (valve-in-mitral annular calcification) in the United States: data from the Society of Thoracic Surgeons/American College of Cardiology/Transcatheter Valve Therapy Registry. Circ Cardiovasc Interv 2020; 13: e008425. doi: 10.1161/CIRCINTERVENTIONS.119.008425
[31]	Simonato M, Whisenant B, Ribeiro HB, et al. Transcatheter mitral valve replacement after surgical repair or replacement: comprehensive midterm evaluation of valve-in-valve and valve-in-ring implantation from the VIVID registry. Circulation 2021; 143: 104−116. doi: 10.1161/CIRCULATIONAHA.120.049088
[32]	Chikwe J, Goldstone AB, Passage J, et al. A propensity score-adjusted retrospective comparison of early and mid-term results of mitral valve repair versus replacement in octogenarians. Eur Heart J 2011; 32: 618−626. doi: 10.1093/eurheartj/ehq331
[33]	Vassileva CM, McNeely C, Spertus J, et al. Hospital volume, mitral repair rates, and mortality in mitral valve surgery in the elderly: an analysis of US hospitals treating Medicare fee-for-service patients. J Thorac Cardiovasc Surg 2015; 149: 762−768.e1. doi: 10.1016/j.jtcvs.2014.08.084
[34]	Gaur P, Kaneko T, McGurk S, et al. Mitral valve repair versus replacement in the elderly: short-term and long-term outcomes. J Thorac Cardiovasc Surg 2014; 148: 1400−1406. doi: 10.1016/j.jtcvs.2014.01.032