Browse/search for people

Publication - Professor Massimo Caputo

    Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: the Mitral Surgery in Octogenarians (MiSO) study


    Chivasso, P, Bruno, VD, Farid, S, Malvindi, PG, Modi, A, Benedetto, U, Ciulli, F, Abu-Omar, Y, Caputo, M, Angelini, G, Livesey, S & Vohra, H, 2017, ‘Predictors of survival in octogenarians after mitral valve surgery for degenerative disease: the Mitral Surgery in Octogenarians (MiSO) study’. Journal of Thoracic and Cardiovascular Surgery.



    An increasing number of octogenarians are referred to undergo mitral valve surgery for degenerative disease and percutaneous approaches are being increasingly employed in this subgroup of patients. We sought to determine the survival and its predictors after mitral valve surgery in octogenarians (MiSO) in a multi-centre UK study of high volume specialist centres.


    Pooled data from 3 centres was collected retrospectively. To identify the predictors of short term composite outcome of 30 days mortality, acute kidney injury (AKI) and cerebrovascular accident (CVA), a multivariable logistic regression model was developed. Multiple Cox regression analysis was performed for late mortality. Kaplan Meier curves were generated for long-term survival in various subsets of patients. ROC analysis was done to determine the predictive power of logistic Euroscore.


    A total of 247 patients were included in the study. The median follow-up was 2.9 years (min 0, max 14 years). One hundred and fifty patients (60.7%) patients underwent mitral valve repair (MVr) and 97(39.3%) patients underwent mitral valve replacement (MVR). Apart from redo cardiac surgery [MVr 6(4%) vs MVR 11(11.3%), p=0.04] and preoperative atrial fibrillation [MVr 79(52.6%) vs MVR 34(35.1%), p<0.01], there was no significant difference in terms of any other preoperative characteristics between the 2 groups. Patient operative risk, as estimated by logistic Euroscore, was lower in the MVr group (10.2±11.8 vs 13.7±15.2 in MVR; p=0.07). No difference was found between groups for duration of cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times. 30-day mortality for the whole cohort was 13.8% (MVr 4.7% vs MVR 18.6%; p<0.01). No differences were found in terms of post-operative CVA (2% vs 3.1%; p=0.9), AKI requiring dialysis (6.7% vs 13.4%; p=0.12) and superficial or deep sternal wound infection (10% vs 16.5%, p=0.17; 2% vs 3.1%, p=0.67, respectively). The final multiple regression model for short-term composite outcome included previous cardiac surgery (OR 4.47; 95% CI: 1.37-17.46; p=0.02), IABP usage (OR 4.77; 95% CI: 1.67-15.79; p<0.01) and MVR (OR 7.7; 95% CI: 4.04-14.9; p<0.01). Overall survival for the entire cohort at 1, 5 and 10 years was 82.4%, 63.7% and 45.5% (MVr vs MVR: 89.9% vs 70.7% at 1 year, 69.6% vs 54% at 5 years and 51.8% vs 35.5% at 10 years; p=0.0005). Cox Proportional hazard model results showed MVR (HR 1.88; 95%CI: 1.22-2.89; p<0.01) and IABP usage (HR 2.54; 95% CI: 1.26-5.13; p<0.01) to be independent predictor factors affecting long term survival. Logistic Euroscore did not perform well in predicting early mortality (AUC 0.57%).


    In octogenarians, MVr for degenerative disease is associated with good survival and remains the gold standard while MVR is still associated with significant mortality. Logistic Euroscore was unable to predict early mortality in our cohort of patients. Larger international multi-centres registries are required to optimize the decision making process in such a high risk subgroup.

    Full details in the University publications repository