Early Surgery Best for This Mitral Valve Leak - a good Davinci application
Early Surgery Best for This Mitral Valve Leak .............Published: Aug 13, 2013
By Crystal Phend, Senior Staff Writer, MedPage Today
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco
Early surgical repair of severe mitral valve regurgitation from flail leaflets improved long-term outcomes compared with waiting until symptoms or other surgical indications appeared.
Point out that the benefit of early surgery held even in the absence of traditional class I triggers for surgery and didn't come with any extra risk of atrial fibrillation overall.
Early surgical repair of severe mitral valve regurgitation from flail leaflets improved long-term outcomes compared with waiting until symptoms or other surgical indications appeared, a registry study showed.
Repair within 3 months of diagnosis in absence of traditional class I indications was associated with roughly half the mortality risk of watchful waiting, for 10-year survival rates of 86% versus 69% (P
Early Surgery Best for This Mitral Valve Leak - a good Davinci application continued...
The six tertiary referral centers (in Belgium, France, Italy, and the U.S.) participating in the registry averaged only seven such asymptomatic patients per year, she pointed out.
However, that clearly needs to change based on the findings, commented Husam H. Balkhy, MD, director of minimally invasive and robotic cardiac surgery at the University of Chicago.
If there is access to a mitral valve repair center with low perioperative mortality, "patients can be and should be referred earlier to maximize long-term benefits of early surgery," he told MedPage Today in an interview.
A randomized comparison would be difficult to do, so this is likely the best data clinicians will get, he suggested.
Otto agreed that the data supported recommendations for early surgery if the surgical risk is low and the likelihood of successful valve repair high, "which is often the case for patients with a flail leaflet."
But appropriateness of early repair remains uncertain for those with high surgical risk or low likelihood of repair when left ventricular size and systolic function are normal, she cautioned.
The Mitral Regurgitation International Database registry included all 1,021 of 2,097 consecutive severe flail mitral valve patients from 1980 through 2004 who didn't have definite indications for surgical intervention -- symptoms, a left ventricular ejection fraction less than 60% or an end-systolic dimension of 40 mm or more -- or other valve disease or congenital heart disease.
Among the 575 patients initially managed medically, 339 patients (59%) ended up getting surgery later, at a median 1.65 years after diagnosis.
Still, the mortality advantage to early surgery at 10 years persisted across the various analyses, with a hazard ratio of 0.55 in the adjusted models, 0.52 in a cohort propensity matched on 32 variables, and 0.66 in an inverse probability-weighted analysis -- all statistically significant.
Patients with class II triggers for surgery -- atrial fibrillation at diagnosis, pulmonary hypertension, or both -- showed a similar survival benefit at 10 years (76% early surgery versus 44% not, P