Early Surgery for Mitral Regurgitation Has Best Outcomes

A new study indicates that delaying surgery until clinical mitral regurgitation (MR) triggers appear leads to increased mortality and congestive heart failure (HF).

Researchers at the Mayo Clinic (Rochester, MN, USA) conducted a study that reviewed 1,512 patients (mean age 64) who underwent surgical correction of pure organic MR between 1990 and 2000. The patients were stratified according to surgical indication into class I triggers (HF symptoms, ejection fraction under 60%, and end-systolic diameter over 40 mm), class II triggers based on clinical complications (atrial fibrillation (AF) or pulmonary hypertension), or early class II triggers, based on a combination of severe MR and high probability of valve repair.

The results showed that 15-year survival was 42% in the Class I group, 53% in the Class II group, and 70% in the early surgery group. During follow-up, 302 patients developed postoperative HF, with an approximately 2.5 times increased risk of HF in the Class I trigger group, and double the risk in the Class II trigger group. Significant differences between groups were also found for the combined end-point of death or congestive HF; 37% in the early surgery group versus 65% in the Class I trigger group and 55% in the Class II group. The study was published in the July 2015 issue of the Journal of Thoracic and Cardiovascular Surgery.

“The type of guideline-based indication for surgical correction of organic mitral regurgitation is associated with profound outcome consequences on long-term postoperative mortality and heart failure, despite low operative risk and high repair rates,” concluded lead Maurice Enriquez-Sarano, MD, and colleagues. “Conversely, surgical correction of severe mitral regurgitation based on high probability of repair is associated with improved survival and low heart failure risk, and should be the preferred strategy in valve centers offering low operative risk and high repair rates.”

Mitral regurgitation, the most common form of valvular heart disease, is a disorder of the heart in which the mitral valve does not close properly, causing regurgitation of blood from the left ventricle through the mitral valve and into the left atrium when the left ventricle contracts, causing blood to return back into the left atrium. Patients with MR face a dilemma of whether to undergo corrective surgery early, when they might have no or few symptoms, or wait until their condition worsens, triggering the decision to proceed with surgery.

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