Life Expectancy in U.S. Population
Current perspective on the elderly by Blase A. Carabello
(from: “The Current Therapy for Mitral Regurgitation, Journal of the American College of Cardiology.2008;52:319-26)
- Age has historically been seen as having a negative impact on surgical outcomes.
- “ ... more recent studies in the elderly show a marked improvement in operative mortality and late survival, especially when MVRe [mitral valve repair] is used.”
- While surgical intervention is not recommended for asymptomatic elderly patients, “ ... surgery should not be withheld in older symptomatic patients, especially when MVRe is likely.”
- “ ... patients with primary MR and low ejection fraction were [previously] considered inoperable ... . It is now known that although prognosis is reduced in such patients, MVRe can improve symptoms and is relatively well tolerated.”
Current ACC/AHA Guideline Perspective on LV dysfunction
"Determining the surgical candidacy of the symptomatic patient with MR and far-advanced LV dysfunction is a common clinical dilemma. The question that often arises is whether the patient with MR has such advanced LV dysfunction that he or she is no longer a candidate for surgery.
Often such cases present difficulty in distinguishing primary cardiomyopathy with secondary MR from primary MR with secondary myocardial dysfunction.
In the latter case, if MV repair appears likely, surgery should still be contemplated. Even though such a patient is likely to have persistent LV dysfunction, surgery is likely to improve symptoms and prevent further deterioration of LV function.”
So, how can we prevent potential undertreatment of valve disease from happening to our Mercy patients?
- Establish system-wide protocol that identifies patients with symptomatic severe valve disease
- Develop an integrated referral process that facilitates timely patient evaluation
- Use a multidisciplinary approach to patient evaluation, diagnosis, and treatment recommendation
- Create a database to track diagnosis, treatment, and follow-up of patients referred to the valve clinic
- Educate referral network on potential undertreatment and valve clinic process