Mitral valve surgery in octogenarians: should we fight for repair? A survival and quality-of-life assessment
Bibliographic record
Abstract
OBJECTIVE: The aim of the study was to evaluate survival and quality of life after mitral surgery in octogenarians. METHODS: From 1987 to 2007, 129 patients ≥ 80 years (median age 82 years; minimum 80 years and maximum 89 years) underwent mitral surgery (87.6% myxomatous, 10% rheumatic, and 2.3% ischemic) with repair procedure in 75 patients and replacement in 54 patients. In the repair and the replacement groups, respectively: Logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 5.77 (3.5-63) versus 11.1 (3.5-93.2); and significative preoperative differences were diabetes mellitus (1.3% vs 16.7%, p=0.002) and previous cardiac surgery (0% vs 16.7%, p=0.0001). Survival and quality of life (walking test) were assessed. RESULTS: In the repair and the replacement groups, respectively, hospital mortality (1 month) was 2.7% versus 18.5% (p=0.004). Early (1-6 months) mortality remained high with 9.6% versus 13.6% (p=0.55). Late mortality (6 months-7 years) was stable with an annual mortality of 8% versus 6% per year (p=0.32). The replacement procedure was the only significative predictor of mortality with an odds ratio (OR) of 6.7 (1.1-38.8 (p=0.04)) for operative mortality. Regarding quality of life, with 41 months' (1.1-180) (100%) follow-up, 54.2% (65.9%) of repair (replace) patients were living in a nursing home and walking distance without aid was more than 500 m in 67.1% (81.2%) of patients. CONCLUSIONS: For elderly patients, 6-month mortality better reflects the burden of mitral surgery than the usual 1-month mortality. Even though replacement patients have higher operative estimated risk, mitral replacement remains, after adjustment, an independent predictor of higher operative mortality. Our results claim for wider use of repair technique in mitral surgery for the octogenarians, even if replacement is an acceptable option when repair is technically uncertain.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.018 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.008 | 0.034 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".