Does mitral valve replacement or repair improve survival compared to medical treatment in high-risk patients with chronic nonischemic mitral regurgitation?
In high-risk patients with chronic nonischemic mitral regurgitation and ventricular dysfunction, mitral valve surgery significantly improves long-term survival compared to medical therapy, with preoperative right ventricular ejection fraction serving as a key predictor of postoperative mortality.
Among patients with chronic nonischemic mitral regurgitation (MR), high short-term mortality risk can be identified by left (LV) and/or right ventricular (RV) ejection fraction (EF) criteria (LVEF 20%, MVR significantly improved survival versus medical treatment (rest: p < 0.0001, exercise: p = 0.0003). In high risk MR patients, MVR improves survival; preoperative RV performance can define subgroups with different long-term postoperative survival.
Wencker et al. (2000) studied this question.