Why the study?
Current guidelines recommend considering surgery for asymptomatic severe mitral regurgitation, but long-term prognosis and optimal treatment for moderate mitral regurgitation remain uncertain.
Does mitral valve surgery improve all-cause mortality in asymptomatic patients with holosystolic degenerative mitral regurgitation compared to medical therapy?
Population
449 asymptomatic patients with holosystolic degenerative MR
Comparison
Baseline MR severity quantified by ERO under medical therapy vs subsequent surgical correction
Design
Single-center prospective cohort study with extended follow-up
Follow-up
Median 26 years
Key result
Increasing baseline effective regurgitant orifice area was associated with higher mortality under medical therapy (HR per IQR increase 2.53; 95% CI 1.30-4.93; P=0.01).
Authors
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Baseline MR severity may aid risk stratification in asymptomatic patients; leaves open whether surgery improves survival.
Cohort (n=449)
No
Does mitral valve surgery improve all-cause mortality in asymptomatic patients with holosystolic degenerative mitral regurgitation compared to medical therapy?
Hazard Ratio: 2.53 (95% CI 1.3–4.93)
p-value: p=.01
In asymptomatic patients with degenerative mitral regurgitation, surgical treatment is associated with improved long-term survival in those with upper-moderate MR (ERO 30-39 mm2).
Karadzha et al. (2026) conducted a cohort in asymptomatic patients with holosystolic degenerative mitral regurgitation (n=449). Baseline MR severity quantified by effective regurgitant orifice area (ERO) vs. Lower ERO categories was evaluated on All-cause mortality (HR 2.53, 95% CI 1.30-4.93, p=.01). Increasing baseline effective regurgitant orifice area was associated with higher mortality under medical therapy (HR per IQR increase 2.53; 95% CI 1.30-4.93; P=0.01).