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  • Review Article
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Treatment of degenerative mitral regurgitation in elderly patients

Nature Reviews Cardiology volume 12, pages 177–183 (2015)Cite this article

Subjects

Key Points

  • The prevalence of mitral valve disease increases with age; >10% of patients aged >75 years who require hospitalization have substantial mitral regurgitation, predominantly of degenerative aetiology

  • Surgical valve repair is the preferred treatment for severe degenerative mitral regurgitation (DMR), but is contraindicated in many elderly patients owing to high procedural risk and the presence of comorbidities

  • In elderly patients, nonsurgical treatment for DMR is a low-risk option associated with clinical improvement and an accelerated recovery to active living

  • Percutaneous valve repair has become an alternative therapeutic option for patients who are not eligible for conventional surgical treatment of DMR

  • The balance between the risks and benefits, and the value versus the futility of procedures to treat DMR in elderly patients should be assessed by a multidisciplinary care team

Abstract

Advanced age is a common contraindication for cardiac surgery, particularly in high-risk patients with comorbidities, such as pulmonary and renal impairment, associated coronary artery disease, and neurological disorders. In elderly patients with degenerative mitral regurgitation who are not eligible for conventional surgical valve repair or replacement, percutaneous valve repair is emerging as a viable alternative therapeutic option. Nonsurgical and minimally invasive therapies for degenerative mitral regurgitation are of particular value in this subset of patients, because these interventions are associated with reduced perioperative mortality, clinical improvement, and faster recovery than is possible with surgical procedures. However, given that surgery remains the gold-standard treatment and should still be considered an option regardless of a patient's age, transcatheter mitral valve repair should be performed only in candidates who will gain the most benefit from it. The balance between the risks and benefits, and the value versus the futility of procedures to treat degenerative mitral regurgitation in elderly patients should be assessed by a specialized multidisciplinary care team. In this Review, we discuss the treatment options and indications for degenerative mitral regurgitation in elderly patients.

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Figure 1: Intraoperative view of the mitral valve during minimally invasive surgical repair.

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Acknowledgements

We acknowledge Andrea Guidotti (University Hospital, Zürich) for his assistance.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, University Hospital Zürich, Rämistrasse 100, Zürich, 8006, Switzerland

    Maurizio Taramasso & Francesco Maisano

  2. Department of Cardiology, University Hospital Zürich, Rämistrasse 100, Zürich, 8006, Switzerland

    Oliver Gaemperli

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  1. Maurizio Taramasso
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  3. Francesco Maisano
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Contributions

M.T. researched data for the article, and all the authors contributed to discussions of its content. M.T. and F.M. wrote the manuscript, and O.G. and F.M. reviewed and edited the article before submission.

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Correspondence to Maurizio Taramasso.

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The authors declare no competing financial interests.

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Taramasso, M., Gaemperli, O. & Maisano, F. Treatment of degenerative mitral regurgitation in elderly patients. Nat Rev Cardiol 12, 177–183 (2015). https://doi.org/10.1038/nrcardio.2014.210

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