Minimally Invasive Mitral Valve Surgery in Elderly Patients: Results from a Multicenter Study

Background: Minimally invasive mitral valve surgery (MIMVS) has been increasingly adopted worldwide as an alternative to conventional sternotomy, especially for young patients. The remarkable results gained by MIMVS have encouraged its application in more complex and fragile patients, such as the elderly, though results in this subgroup remain controversial. It is the aim of this study to assess the postoperative outcomes of patients older than 75 years old undergoing MIMVS, and to compare these results to those of younger patients. Methods: The data of all patients undergoing MIMVS between 2015 and 2022 were retrospectively collected at seven high-volume cardiac surgery centers. Patients were divided into two age-based groups: the young (<65 years old) and the elderly (>75 years old). A propensity score (PS) matching analysis obtained two comparable groups. Postoperative outcomes were assessed in both the unmatched and PS-matched populations. Results: Out of 1113 patients undergoing MIMVS, 524 were young and 279 were elderly. Elderly patients were more commonly affected by multiple comorbidities, with a higher EuroSCORE II (4.6 +/- 5.5% vs. 1.6 +/- 3.3%, p < 0.001). There was no difference in postoperative mortality, though the elderly had a greater incidence of postoperative complications, such as re-exploration for bleeding, stroke, reintubation, and a need for hemodialysis and blood transfusions. After PS matching, 119 pairs of young and elderly patients with similar risk profiles (EuroSCORE II 2.5 +/- 4.7% vs. 2.7 +/- 3.2%, p = 0.7) were compared, and no differences in all postoperative outcomes were found. Conclusions: Adequately selected elderly patients can report hospital outcomes similar to young patients after MIMVS.