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Ask the doctor: Is mitral valve surgery safe for an 82-year-old?

Ask the doctor

Is mitral valve surgery safe for an 82-year-old?

Q. My 82-year-old father needs to have his mitral valve fixed. It took him a long time to recover from having an aortic aneurysm repaired, so he is procrastinating on the valve operation. Can he put it off? If not, are there alternatives to open-heart surgery?

A. Your father is justified in worrying about having a major operation like this at his age. Complications and surgery-related death are much more common among older people. At the same time, not having the operation could also be life-threatening. A leaky mitral valve makes the heart work harder than it should. When it can no longer pump enough blood to meet the body's needs, blood can back up into the lungs, making breathing difficult. This valve problem can lead to heart failure and unstable heart rhythms, both of which can interfere with daily life and be deadly. Fixing the valve can add years to your dad's life and improve his quality of life.

The outlook for valve repair in the elderly is much better than it used to be. In a report in the July 25, 2006, Circulation, doctors from the Mayo Clinic showed dramatic improvements in the success of mitral valve operations for people ages 75 and older over the past 25 years. The chances of dying as a result of the operation dropped from above 25% in 1980 to about 5%.

Ongoing advances in surgical techniques, anesthesia, planning before the operation, and supportive care afterward may lower the risk even further. And teams around the world are testing ways to fix leaky heart valves without opening the chest. None of these are ready for routine use.

If your father can have his valve repaired instead of replaced, that would spare him the risk of infection and blood clots that an artificial heart valve might carry. Some medical centers now offer "keyhole" surgery for fixing mitral valves. Instead of opening the chest and splitting the breastbone, the surgeon operates through small incisions between the ribs.

Whatever route your father chooses, find a surgeon who does the procedure often in a medical center where it is performed all the time. Your father's cardiologist should be able to steer him in the right direction.

— Thomas Lee, M.D. Editor in Chief, Harvard Heart Letter

Last updated:	September 05, 2008