Early Surgery in Patients With Mitral Regurgitation Due to Flail Leaflets

• DOI: 10.1161/01.cir.96.6.1819
• Publication Date: 2012-06-12T00:41:02Z
• Authors: Lieng H. Ling; Maurice Enriquez-...; James B. Seward; Thomas A. Orszulak; Hartzell V. Schaff; Kent R. Bailey; A. Jamil Tajik; Robert L. Frye
• Keywords: Aged, 80 and over; Heart Failure; Male; Time Factors; Endocarditis; Mitral Valve Insufficiency; Hemorrhage; Middle Aged; Prognosis; Survival Analysis; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Echocardiography; Cause of Death; Thromboembolism; Atrial Fibrillation; Humans; Mitral Valve; Female; Aged; Follow-Up Studies

Background The optimal timing for surgery in patients with mitral regurgitation is disputed. Because of the frequency left ventricular dysfunction, which difficult to predict, early has been recommended, but its potential benefits have not demonstrated. Methods and Results outcomes 221 (mean age, 65±13 years; 71% males) flail leaflets diagnosed two-dimensional echocardiography between 1980 1989 who were eligible operation analyzed. Group I comprised 63 had valve (within 1 month after diagnosis). II 158 initially treated conservatively (80 whom operated on later). younger ( P =.009), more symptoms <.0001), frequently atrial fibrillation =.023) than group patients. There was no difference ejection fraction groups. strategy followed by an improved overall survival rate P= .028) a lower incidence cardiovascular deaths =.025), congestive heart failure =.046), new chronic =.032), as confirmed multivariate analysis (adjusted risk ratios 0.31, 0.18, 0.38, 0.05, respectively; all P< .02). Conclusions In due leaflets, versus conservative management associated long-term rate, decreased cardiac mortality, morbidity diagnosis. This outcome advantage suggests that reasonable treatment option be considered low-risk candidates repairable valves severe regurgitation.