Poor Guideline Adherence Found for Mitral Regurgitation

Only about half of patients undergo the recommended surgery, study suggests

TUESDAY, Aug. 18 (HealthDay News) -- Only about half of patients with mitral regurgitation (MR) undergo surgery as recommended by accepted guidelines, even though about three-quarters of unoperated patients have at least one indication for surgery, according to a study in the Aug. 25 issue of the Journal of the American College of Cardiology.

David S. Bach, M.D., and colleagues from the University of Michigan in Ann Arbor reviewed adherence to guideline recommendations in 300 patients with moderate-to-severe or severe MR (188 with functional MR, 112 with organic MR) at one large tertiary medical center.

The researchers found that the recommended surgery was performed in 16 percent of functional MR patients (mostly for heart failure or during another cardiac surgical procedure) and 53 percent of organic MR patients. Common reasons for not performing surgery for organic MR were stable left ventricular size or function, absence of symptoms, and prohibitive comorbidities. At least one American College of Cardiology/American Heart Association indication for surgery was present in 74 percent of the 53 unoperated organic MR patients. However, perioperative mortality risk was similar regardless of whether surgery was performed (1.1 to 1.2 percent).

"Among patients with severe organic MR, surgical intervention occurred in approximately one-half," Bach and colleagues conclude. "However, accepted guideline indications for intervention were present in the majority of unoperated patients."

The study was partly funded by Edwards Lifesciences, and one co-author reported financial and consulting relationships with Edwards Lifesciences and other companies.

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