Key result
In asymptomatic patients with severe degenerative mitral regurgitation without high-risk features, both conservative surveillance and early mitral valve repair are reasonable initial management strategies.
Why the study?
Does early mitral valve surgery improve outcomes in asymptomatic patients with severe degenerative mitral regurgitation compared to conservative management?
Does early mitral valve surgery improve outcomes in asymptomatic patients with severe degenerative mitral regurgitation compared to conservative management?
The review highlights that while watchful waiting is safe for asymptomatic severe degenerative mitral regurgitation, early surgery may be beneficial if performed in high-volume centers, guided by risk stratification using echocardiography and biomarkers.
Supports individualized decisions for asymptomatic severe degenerative mitral regurgitation; leaves open need for randomized trials to guide timing.
Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
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Dolor-Torres et al. (2012) conducted a review in Degenerative Mitral Regurgitation. Mitral valve surgery vs. Conservative management (watchful waiting) was evaluated. In asymptomatic patients with severe degenerative mitral regurgitation without high-risk features, both conservative surveillance and early mitral valve repair are reasonable initial management strategies.
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