Long-Term Outcomes after Early Surgery for Asymptomatic Severe Degenerative Mitral Regurgitation

Abstract

Aim:To compare early surgical intervention and conservative treatment in terms of long-term clinical outcomes in patients with asymptomatic severe degenerative mitral regurgitation (DMR).

Background:Even though there are guidelines on the idea that early mitral valve repair in symptomatic patients with severe DMR have proven to be effective, there are conflicting reports as to the long-term effectiveness of early repair as compared to watchful waiting. The elucidation of these results is of essence in refining treatment modalities as well as barring the imminent irreversible remodeling of the left-ventricle.

Methods:A retrospective cohort study was studied on 1,120 patients who had asymptomatic severe DMR treated in three tertiary centers. The subjects were categorized in two cohorts; early mitral valve repair that takes a six-month duration of the condition and the control group that followed up to the development of the symptoms or normal standard guideline indicators. They were followed across a medium of follow-up of 10.2 years and the relevant outcomes were all-cause mortality, heart-failure hospitalization, new-onset atrial fibrillation and requirement of reoperation.

Results:The early surgery was connected with much less all-cause mortality (HR 0.62, p=0.01) and heart-failure hospitalization (HR 0.55, p=.001). The rates of new-onset atrial fibrillation were also lower in the group of early-surgery. The reoperation rates did not vary significantly among groups.

Conclusion:Asymptomatic severe DMR in patients undergoing early mitral valve repair has had a better survival and less heart-failure incidence in the long run than conservative treatment. These results precondition the use of early surgery in fitting patients.