Does early mitral valve repair improve outcomes compared to a watchful waiting approach in asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular function?
This review highlights the ongoing debate and lack of randomized evidence regarding the optimal timing of surgery (early repair vs. watchful waiting) for asymptomatic severe degenerative mitral regurgitation with preserved LV function.
Mitral valve repair represents the optimal surgical treatment for severe degenerative mitral regurgitation. According to the current guidelines, mitral repair is indicated in the presence of symptoms and/or signs of left ventricular (LV) dysfunction. In asymptomatic patients with preserved LV function, surgery should be considered in the presence of atrial fibrillation (AF) and/or pulmonary hypertension. In asymptomatic patients with preserved LV function, normal pulmonary artery pressure, and no episodes of AF, surgical timing is still an object of debate. The controversial issue is whether, in those circumstances, a 'wait and see (watchful waiting)' approach should be followed or an 'early repair' policy should be preferred. Indeed, a randomized trial comparing the two strategies has never been performed. In the absence of evidence-based arguments definitely supporting any particular course of action, advantages, drawbacks, and requirements for both strategies will be discussed in this review on the basis of the most significant observational studies which have focused on this issue.
“The results of the current study showed that early surgery provided significant benefits over watchful waiting — and interestingly, were of a magnitude greater than we anticipated. This is perhaps counterintuitive. Patients assume they are more severely affected if they need surgery. Actually the opposite is true. Once a patient develops severe mitral valve leakage — even without symptoms — we now know that it is preferable to promptly repair the leakage rather than letting the heart deteriorate.”
Bonis et al. (2012) studied this question.
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