Early Surgery Best for Mitral Valve Leaks

Early surgical repair of severe mitral valve regurgitation from flail leaflets improves long-term outcomes, according to a new study.

Researchers at the Mayo Clinic (Rochester, MN, USA), the University of Bologna (Italy), and other institutions conducted a study involving 2,097 consecutive patients in the Mitral Regurgitation International Database (MIDA) registry with flail mitral valve regurgitation to establish the comparative effectiveness of nonsurgical observation and early surgery. The patients received routine cardiac care at six tertiary centers between 1980 and 2004, with mean follow-up of 10.3 years, with the main outcome measure being the association between treatment strategy and survival, heart failure, and new-onset atrial fibrillation (AF).

The results showed that there was no significant difference in early mortality and new-onset heart failure rates between treatment strategies at three months. In contrast, long-term survival rates were higher for patients with early surgery. Long-term heart failure risk was also lower with early surgery. Reduction in late-onset AF was not observed. The study was published in the August 14, 2013, issue of the Journal of the American Medical Association (JAMA).

“Repair within three months of diagnosis in absence of traditional class I indications was associated with roughly half the mortality risk of watchful waiting, for 10-year survival rates of 86% versus 69%,” concluded lead author Rakesh Suri, MD, PhD, of the Mayo Clinic, and colleagues. “Those benefits held even in the absence of traditional class I triggers for surgery and didn't come with any extra risk of atrial fibrillation overall.”

Flail leaflet prolapse occurs when a leaflet tip turns outward, becoming concave toward the left atrium, causing the deterioration of the mitral valve. The severity of flail leaflet varies, ranging from tip eversion to chordal rupture. The term itself refers to the dissociation of leaflet and chordae tendineae, providing for unrestricted motion of the leaflet. Patients with flail leaflets have a higher prevalence of mitral regurgitation than those with the non-flail subtype.

Related Links:
Mayo Clinic
University of Bologna