10 Approximately 53% had symptoms of severe heart failure at the time of either operation (NYHA class III–IV). Overall, operative mortality was about 2.6%. By age quartile of 65–69 years, 70–74 years, 75–79 years, and 80 years or greater, the operative mortality was 1.7% (72 of 4,311), 1.9% (85 of 4,426), 3.4% (126 of 3,669), and 4.3% (95 of 2,198), Inhibitors,research,lifescience,medical respectively. Operative mortality was significantly higher among patients with advanced heart failure at the time of operation (1.5% in NYHA class I or II versus 3.3% in NYHA class III or IV, P < 0.0001). Mean follow-up was 6

years. The 10-year survival rate after mitral valve repair was 57%, identical Inhibitors,research,lifescience,medical to that of the normal age- and sex-matched US population. Five-year survival was 68% among patients with NYHA class III–IV compared with 85% among those with NYHA class I–II (hazard ratio class III–IV versus class I–II: 2.65). The numbers of observed events for mitral reoperation, heart failure, bleeding, and stroke were 552 of 14,604 (3.7%), 2,681 of 14,604 (18.4%), 1,051 of 14,604 (7.2%), and 1,131 of 14,604 (7.7%), respectively. Advanced preoperative symptoms were strongly associated with 5-year readmission for congestive heart failure after Inhibitors,research,lifescience,medical successful mitral valve repair (NYHA class IV 33% versus NYHA class I–II 14%; hazard ratio 2.76). Seeburger et

al. recently reported the different single-center experience with 2,053 elderly (defined as 70 years or older) patients who underwent mitral valve (MV) surgical procedures with or without Inhibitors,research,lifescience,medical associated procedures.12 Seventy-seven patients (3.1%) died within 30 days after the operation. Postoperative low cardiac output syndrome was seen in 316 patients (12.6%) Inhibitors,research,lifescience,medical and treated with inotropic support, the application of an

intra-aortic balloon pump, or both. Cerebrovascular accidents, including transient and persistent neurologic deficits, occurred in 105 patients (4.2%). Implantation of a pacemaker during the postoperative course was indicated in 268 Brefeldin_A patients (10.7%). Incidence of acute renal failure was 16.7% (418 patients). Patients were discharged from hospital for further rehabilitation treatment at 17.3 ± 11.7 days after operation. Concomitant coronary artery bypass surgery (CABG) was a significant risk factor for increased early mortality (odds ratio 2.3, P = 0.016). Age stratification revealed a significantly better 5-year survival for patients between the ages of 70 and 75 years of 58.6%, compared with 52.9% at the age of 75 to 80 years, and 47.9% at the age of >80 years. Associated co-morbidities (including diabetes, pulmonary disease, perioperative hemodialysis, low ejection fraction, and need for associated tricuspid valve procedure) were associated with an increased risk of late death.