Early Mitral Surgery Best for Mitral Valve Regurgitation
Long-term outcomes better with early surgery, including for patients without class I triggers
TUESDAY, Aug. 13 (HealthDay News) -- For patients with mitral valve regurgitation due to flail mitral leaflets, early mitral surgery is associated with improved long-term outcomes compared to initial medical management, according to a study published in the Aug. 14 issue of the Journal of the American Medical Association.
Rakesh M. Suri, M.D., D.Phil., from the Mayo Clinic College of Medicine in Rochester, Minn., and colleagues compared the effectiveness of initial medical management (nonsurgical observation) with early mitral valve surgery following the diagnosis of mitral regurgitation due to flail leaflets using data from 2,097 patients from the Mitral Regurgitation International Database registry. Of the 1,021 patients with mitral regurgitation without American College of Cardiology and American Heart Association guideline Class I triggers, 575 underwent medical management and 446 underwent early surgery.
The researchers observed no significant difference in early mortality or new-onset heart failure rates between the treatment groups at three months. Long-term survival rates were higher for patients with early surgery (86 versus 69 percent at 10-years), and the advantage was seen in adjusted models, a propensity matched cohort, and in an inverse probability-weighted analysis. For patients with class II triggers, similar results were observed in relative reduction in mortality following early surgery. After early surgery, the long-term heart failure risk was also significantly lower (7 versus 23 percent at 10-years), and this reduction was confirmed in all statistical models. There was no reduction in late-onset atrial fibrillation.
"The advantages associated with early surgical correction of mitral valve regurgitation were confirmed in both unmatched and matched populations, using multiple statistical methods," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.