MITRAL VALVE REPAIR FOR MITRAL REGURGITATION IN THE ELDERLY: YES, WE
HAVE TO, BUT LOOK AT THE ETIOLOGIES!
The meta-analysis by Di Tommaso et al demonstrated as elderly patients
with mitral regurgitation (MR) undergoing mitral valve repair (MVr) had
lower short-term mortality and higher long-term survival with respect to
patients undergoing mitral valve replacement (MVR). The benefit of
repair is such, that initial surgical strategy is advisable in the
elderly even in case of mild symptoms if compared with conservative
management. However, even if repair can be performed in presence of some
specific etiologies, as degenerative MR or secondary MR, there are
always cases where a replacement can be an acceptable solution compared
to a repair with uncertain future, regardless of our believes and our
technical ability. In this subset of patients, the literature does not
show any improvement in outcome of transcatheter mitral repair. Mitral
valve repair has to be always done, but look at the etiologies and to
the consequences that what is done today can cause tomorrow.