Management of mitral regurgitation in the elderly patient

Mitral regurgitation is a clinically significant and increasingly common problem in the elderly population. Traditionally, mitral valve surgery has been considered high risk in this population, with a relatively high reported mortality and disappointing long-term survival. Consequently, mitral valve surgery has been reserved for severely symptomatic patients or avoided altogether. However, recently reported improvements in operative outcomes in both younger and elderly patient populations suggest that such a restrictive approach to operative intervention is not necessary. In this current manuscript, we discuss the various etiologies of mitral regurgitation in the elderly population as well as a rational approach to risk stratification and the indications for surgical intervention. Furthermore, we discuss the results of several recent studies that deal with the question of operative outcomes in the elderly population, and conclude with our recommendations for managing this challenging clinical problem.