Background: The aging of the population has led to an increased number of elderly patients to be referred to mitral valve interventions. With the popularization of percutaneous techniques evaluating the surgical outcomes in older patients is crucial. This study aimed to assess operative results in septuagenarians and octogenarians undergoing minimally invasive mitral valve surgery (MVS) in the large cohort of the Mini-Mitral International Registry. Methods: All consecutive patients operated on between 2015 and 2021 were analyzed. Patients were categorized into three groups based on age (<70 years, 70-79 years, and 80-89 years). The primary outcomes were in-hospital mortality and stroke. The secondary outcomes included postoperative complications and length of stay (LOS). Results were adjusted for demographic, clinical and operative factors using multivariable regression analysis. Result: The total cohort included 7507 patients of whom 4752 (63.3%) were <70 years of age, 2181 (29.1%) were 70-79 years old and 574 (7.6%) were 80-99 years old. Septuagenarians and octogenarians had a higher burden of comorbidities and received more frequently mitral valve replacement (instead of repair) and concomitant tricuspid and AF surgery than younger patients. Unadjusted operative mortality and stroke were 0.8%, 3.1% and 5.1% and 0.7%, 1.9% and 2.1% in patients <70 years, 70-79 years and 80-89 years, respectively (p<0.001). After adjustment for confounders, septuagenarians and octogenarians had higher odds of mortality (septuagenarians, OR 2.80, 95%CI 1.69-4.63; octogenarians, OR 2.79, 95%CI 1.41-5.54) and stroke (septuagenarians, OR 2.59, 95%CI 1.64-4.09; octogenarians, OR 1.95, 95%CI 1.02-4.15). Additionally, elderly patients were associated with higher risk of bleeding, dialysis, prolonged ventilation and delirium (Figure 1). Septuagenarians and octogenarians had longer LOS (<70 years, 7 days; 70-79 years, 9 days; 80-89 years, 9 days; p<0.001) and were less likely to be discharged home (<70 years, 43%; 70-79 years, 30.1%; 80-89 years, 27.3%; p<0.001). Conclusions: This large multicentric series provides a profile of septuagenarians and octogenarians currently undergoing mini-MVS and their associated outcomes. While mini-MVS can be accomplished safely in such high risk patients, the older age remains associated with increased risk of mortality and complications. These results may serve a compelling comparator to full sternotomy and catheter-based procedures. LEGEND: Forest plot showing adjusted analysis for mini-MVS outcomes in septuagenarians (70-79 years) and octogenarians (80-89 years)versus patients aged <70 years (reference)
