Early surgery was associated with a significantly lower risk of cardiac mortality (HR 0.109; 95% CI 0.014-0.836; p=0.033) and cardiac events compared to conventional treatment in asymptomatic severe MR.
Cohort (n=610)
Does early surgery reduce mortality and cardiac events in asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function compared to conventional treatment?
Early surgery significantly reduces long-term cardiac mortality and cardiac events compared to conservative management in asymptomatic patients with severe degenerative mitral regurgitation, particularly in those aged 50 years and older.
Hazard Ratio: 0.109 (95% CI 0.014–0.836)
p-value: p=0.033
OBJECTIVES: This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation (MR). BACKGROUND: The timing of surgery in asymptomatic severe MR remains controversial. METHODS: From 1996 to 2009, 610 consecutive asymptomatic patients (364 men, 50 ± 14 years of age) with severe degenerative MR and preserved left ventricular function were evaluated prospectively. Early surgery was performed on 235 patients, and the conventional treatment strategy was chosen for 375 patients. We compared overall mortality, cardiac mortality, and cardiac events (operative mortality, cardiac mortality, repeat surgery, and urgent admission due to heart failure) between the 2 treatment strategies in the propensity score-matched cohort. RESULTS: For the 207 propensity score-matched pairs, early surgery had a lower risk of cardiac mortality (hazard ratio HR: 0.109; 95% confidence interval CI: 0.014 to 0.836; p = 0.033) and cardiac events (HR: 0.216; 95% CI: 0.083 to 0.558; p = 0.002) than conventional treatment. On Cox proportional hazard model analysis, the risk of cardiac events was significantly lower in the early surgery group than in the conventional treatment group in patients aged 50 years of age and older (HR: 0.221; 95% CI: 0.086 to 0.567; p = 0.002), but not significantly different in those younger than 50 years of age (p = 0.20). CONCLUSIONS: Compared with conservative management, early surgery is associated with significant long-term reductions of cardiac mortality and cardiac events in asymptomatic severe MR. These benefits were evident among patients age 50 years of age and older.
“I think these data, along with many other series, are quite important in identifying the risks we have for our patients for waiting too long, and if we can refer our patients to an expert surgical team for these valves to be repaired, their outcomes will be much better”
Kang et al. (Sun,) conducted a cohort in Asymptomatic severe mitral regurgitation (n=610). Early surgery vs. Conventional treatment strategy was evaluated on Cardiac mortality (HR 0.109, 95% CI 0.014-0.836, p=0.033). Early surgery was associated with a significantly lower risk of cardiac mortality (HR 0.109; 95% CI 0.014-0.836; p=0.033) and cardiac events compared to conventional treatment in asymptomatic severe MR.