Key result
Mitral valve surgery was associated with improved survival in heart failure patients with severe primary mitral regurgitation (log-rank P=0.024), but not in those with secondary mitral regurgitation.
Why the study?
While surgery is standard for severe primary mitral regurgitation, its role in severe secondary mitral regurgitation remained debated.
Does mitral valve surgery improve long-term survival in patients hospitalized for heart failure with severe primary or secondary mitral regurgitation?
Cohort (n=1,143)
Does mitral valve surgery improve long-term survival in patients hospitalized for heart failure with severe primary or secondary mitral regurgitation?
Hazard Ratio: 0.46 (95% CI 0.32–0.67)
p-value: p=0.024
Mitral valve surgery is associated with improved survival in heart failure patients with severe primary mitral regurgitation, but not in those with severe secondary mitral regurgitation.
Surgery may improve survival in severe PMR with HF; leaves open benefit in SMR and needs randomized confirmation.
BACKGROUND: While surgery has been the standard treatment for patients with severe primary mitral regurgitation (PMR), the role of surgery for severe secondary mitral regurgitation (SMR) remained debated. We therefore investigated the prognostic differences of surgery for patients with either severe PMR or SMR. METHODS: Subjects hospitalized for heart failure were enrolled from 2002 to 2012. The severity of MR was assessed by continuity equation, and an effective regurgitant orifice area of ≥40 mm 2 was defined as severe. Long-term survival was then identified by the National Death Registry. RESULTS: A total of 1143 subjects (66.4 ± 16.6 years, 65% men, and 59.7% PMR) with severe MR were analyzed. Compared with PMR, patients with SMR were older, had more comorbidities, greater left atrial and ventricular diameter, and less left ventricular ejection fraction (all p < 0.05). While 47.8% of PMR patients received mitral valve surgery, only 6.9% of SMR patients did. Surgical intervention crudely was associated with 54% reduction of all-cause mortality in PMR (hazard ratio, 0.46; 95% confident interval, 0.32-0.67), and 48% in the subpopulation with SMR (0.52, 0.30-0.91). Propensity score matching analysis demonstrated the survival benefits of mitral valve surgery was observed in patients with PMR (log rank p = 0.024), but not with SMR. Among the unoperated subjects, age, renal function, and right ventricular systolic pressure were common risk factors of mortality, regardless of MR etiology. CONCLUSION: Mitral valve surgery for patients with heart failure and severe MR was associated with better survival in patients with PMR, but not in those with SMR.
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Tsai et al. (2023) conducted a cohort in Heart failure with severe mitral regurgitation (n=1,143). Mitral valve surgery vs. No surgery was evaluated on All-cause mortality (HR 0.46, 95% CI 0.32-0.67, p=0.024). Mitral valve surgery was associated with improved survival in heart failure patients with severe primary mitral regurgitation (log-rank P=0.024), but not in those with secondary mitral regurgitation.
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