June 11th, 2012
The Changing Face of Mitral Valve Surgery
It’s not easy to decide whether to refer an elderly patient with severe, symptomatic mitral regurgitation (MR) for surgery. Mitral valve repair and replacement remain the definitive treatments for symptomatic MR, but they come with particularly high risks in the elderly.
Given the lack of U.S. national surveillance data on this topic, my colleagues and I decided to study trends in the performance of mitral valve surgery, as well as postsurgery hospital readmission (30 days) and mortality (30 days and 1 year), for all Medicare fee-for-service beneficiaries from 1999 through 2008. Our results, published in May, included several key findings:
1. Mitral valve surgery patients are getting older: The overall rate of surgery remained relatively constant from 1999 through 2008, but the percentage of surgery patients who were age 85 or older increased from 8.8% to 12.7%.
2. Risk-adjusted mortality declined dramatically, both at 30 days (from 8.1% to 4.2%) and at 1 year (from 15.3% to 9.2%).
3. Risk-adjusted hospital readmission declined modestly (from 23.0% to 21.0%).
4. Improvements were generally seen across age, sex, and race subgroups, but mortality rates remained higher for women than for men − and for nonwhites than for whites − throughout the 10-year period.
Our study was not designed to explore the reasons for improvement. Possible contributors are the increasing rates of mitral valve repair, lower postoperative complications, and changes in referral patterns (e.g., being referred for surgery earlier).
Will these findings change your practice? What are your considerations as you decide whether to refer elderly patients for mitral valve surgery?