Mitral valve disease, particularly in elderly patients with multiple cardiac and systemic complications, continues to pose significant clinical challenges.
However, recent outcomes at KIMS Hospitals, Thane demonstrate that advanced mitral valve surgery – when supported by careful preoperative optimisation, precise surgical planning, and structured postoperative care – can significantly improve recovery and quality of life, even among patients classified as high-risk.
Why Mitral Valve Disease Is More Complex in Elderly Patients
The mitral valve plays a critical role in maintaining efficient blood flow between the left atrium and left ventricle. Severe narrowing or leakage of the valve increases pressure in the lungs, leading to breathlessness, fluid retention, right-sided heart strain, and declining physical capacity.
In elderly patients, this condition is often compounded by long-standing rheumatic heart disease, reduced ventricular function, atrial fibrillation, pulmonary hypertension, tricuspid valve leakage, and coexisting coronary artery disease.
These overlapping factors elevate surgical risk and make postoperative recovery more demanding, requiring specialised ICU care and prolonged rehabilitation.
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High-Risk Elderly Patients Undergo Successful Mitral Valve Surgery
At KIMS Hospitals, Thane, two elderly women with advanced mitral valve disease presented in extremely fragile clinical states. Both experienced severe breathlessness, swelling, and compromised heart function.
One patient had severe mitral regurgitation with markedly elevated pulmonary pressures and associated tricuspid valve leakage, while the other had critical mitral stenosis with significantly enlarged atria and signs of right-sided heart failure.
Instead of proceeding directly to surgery, the clinical team followed a stepwise management protocol. This included intensive care stabilisation, correction of fluid overload, optimisation of cardiac rhythm disturbances, nutritional support, and repeated advanced cardiac imaging.
In one case, medical management led to a significant reduction in pulmonary pressures, improving surgical safety. In the other, right-heart catheterisation confirmed that pulmonary hypertension was reversible, a key determinant for successful surgical intervention.
Personalised Mitral Valve Surgery and Structured Recovery
Following stabilisation, both patients underwent customised surgical correction. Procedures included mitral valve replacement using bioprosthetic valves, closure of the left atrial appendage, and correction of associated tricuspid valve leakage. One patient also required coronary artery bypass grafting to address blocked vessels.
Despite advanced age and high predicted operative risk, both patients demonstrated steady recovery. Their postoperative course included gradual ventilator weaning, intensive physiotherapy, and focused nutritional rehabilitation, underscoring the importance of comprehensive perioperative planning in elderly cardiac patients.
Expert Insight on Managing High-Risk Mitral Valve Disease
Commenting on these outcomes, Dr Saumya Sekhar Jenasamant, Consultant Cardiothoracic & Vascular Surgeon at KIMS Hospitals, Thane, highlighted the importance of individualised treatment strategies in elderly patients with mitral valve disease.
He noted that such cases are rarely limited to valve pathology alone and often involve pulmonary pressure changes, ventricular dysfunction, rhythm disorders, and overall frailty.
According to him, successful outcomes depend on accurate timing, addressing all associated cardiac conditions during surgery, and ensuring structured postoperative rehabilitation.
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Reassessing Surgical Decisions for Elderly Patients
For many families, the idea of open-heart surgery in elderly individuals can be daunting. However, advancements in cardiac imaging, valve technologies, anaesthesia, and multidisciplinary ICU care have transformed the safety and outcomes of mitral valve surgery.
The recent recoveries at KIMS Hospitals reflect a broader shift toward evidence-based decision-making and personalised care pathways. These cases illustrate that, with the right clinical strategy, elderly patients with complex heart disease can achieve meaningful recovery and improved daily functioning.
Key Takeaway
Advanced mitral valve surgery, when thoughtfully planned and executed within a comprehensive care framework, can restore mobility, stability, and quality of life in high-risk elderly patients, reinforcing the value of expert-led, patient-specific cardiac care.
