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Treatment of degenerative mitral regurgitation in elderly patients


Taramasso, Maurizio; Gaemperli, Oliver; Maisano, Francesco (2014). Treatment of degenerative mitral regurgitation in elderly patients. Nature Reviews. Cardiology, 12(3):177-183.

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.

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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Additional indexing

Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiovascular Surgery
Dewey Decimal Classification:610 Medicine & health
Language:German
Date:23 December 2014
Deposited On:10 Feb 2015 15:04
Last Modified:05 Apr 2016 18:56
Publisher:Nature Publishing Group
ISSN:1759-5002
Publisher DOI:https://doi.org/10.1038/nrcardio.2014.210
PubMed ID:25533801

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