Abstract
Background: The optimal timing for surgery in patients with mitral regurgitation is disputed. Because of the frequency of left ventricular dysfunction, which is difficult to predict, early surgery has been recommended, but its potential benefits have not been demonstrated. Methods and Results: The outcomes of 221 patients (mean age, 65±13 years: 71% males) with flail leaflets diagnosed with two-dimensional echocardiography between 1980 and 1989 who were eligible for operation were analyzed. Group I comprised 63 patients who had early mitral valve surgery (within 1 month after diagnosis). Group II comprised 158 patients initially treated conservatively (80 of whom were operated on later). Group I patients were younger (P=.009), had more symptoms (P<.0001), and were more frequently in atrial fibrillation (P=.023) than group II patients. There was no difference in ejection fraction between the groups. The early surgery strategy was followed by an improved overall survival rate (P=.028) and a lower incidence of cardiovascular deaths (P=.025), congestive heart failure (P=.046), and new chronic atrial fibrillation (P=.032), as confirmed by multivariate analysis (adjusted risk ratios of 0.31, 0.18, 0.38, and 0.05, respectively; all P<.02). Conclusions: In patients with mitral regurgitation due to flail leaflets, the strategy of early surgery versus conservative management is associated with an improved long-term survival rate, decreased cardiac mortality, and decreased morbidity after diagnosis. This outcome advantage suggests that early surgery is a reasonable treatment option to be considered in low-risk candidates with repairable valves and severe mitral regurgitation.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1819-1825 |
| Number of pages | 7 |
| Journal | Circulation |
| Volume | 96 |
| Issue number | 6 |
| State | Published - Sep 16 1997 |
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Keywords
- Echocardiography
- Heart failure
- Prognosis
- Valves
ASJC Scopus subject areas
- Physiology
- Cardiology and Cardiovascular Medicine
Cite this
Early surgery in patients with mitral regurgitation due to flail leaflets : A long-term outcome study. / Ling, Lieng H.; Sarano, Maurice E; Seward, James B.; Orszulak, Thomas A.; Schaff, Hartzell V; Bailey, Kent R; Tajik, A. Jamil; Frye, Robert L.
In: Circulation, Vol. 96, No. 6, 16.09.1997, p. 1819-1825.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Early surgery in patients with mitral regurgitation due to flail leaflets
T2 - A long-term outcome study
AU - Ling, Lieng H.
AU - Sarano, Maurice E
AU - Seward, James B.
AU - Orszulak, Thomas A.
AU - Schaff, Hartzell V
AU - Bailey, Kent R
AU - Tajik, A. Jamil
AU - Frye, Robert L.
PY - 1997/9/16
Y1 - 1997/9/16
N2 - Background: The optimal timing for surgery in patients with mitral regurgitation is disputed. Because of the frequency of left ventricular dysfunction, which is difficult to predict, early surgery has been recommended, but its potential benefits have not been demonstrated. Methods and Results: The outcomes of 221 patients (mean age, 65±13 years: 71% males) with flail leaflets diagnosed with two-dimensional echocardiography between 1980 and 1989 who were eligible for operation were analyzed. Group I comprised 63 patients who had early mitral valve surgery (within 1 month after diagnosis). Group II comprised 158 patients initially treated conservatively (80 of whom were operated on later). Group I patients were younger (P=.009), had more symptoms (P<.0001), and were more frequently in atrial fibrillation (P=.023) than group II patients. There was no difference in ejection fraction between the groups. The early surgery strategy was followed by an improved overall survival rate (P=.028) and a lower incidence of cardiovascular deaths (P=.025), congestive heart failure (P=.046), and new chronic atrial fibrillation (P=.032), as confirmed by multivariate analysis (adjusted risk ratios of 0.31, 0.18, 0.38, and 0.05, respectively; all P<.02). Conclusions: In patients with mitral regurgitation due to flail leaflets, the strategy of early surgery versus conservative management is associated with an improved long-term survival rate, decreased cardiac mortality, and decreased morbidity after diagnosis. This outcome advantage suggests that early surgery is a reasonable treatment option to be considered in low-risk candidates with repairable valves and severe mitral regurgitation.
AB - Background: The optimal timing for surgery in patients with mitral regurgitation is disputed. Because of the frequency of left ventricular dysfunction, which is difficult to predict, early surgery has been recommended, but its potential benefits have not been demonstrated. Methods and Results: The outcomes of 221 patients (mean age, 65±13 years: 71% males) with flail leaflets diagnosed with two-dimensional echocardiography between 1980 and 1989 who were eligible for operation were analyzed. Group I comprised 63 patients who had early mitral valve surgery (within 1 month after diagnosis). Group II comprised 158 patients initially treated conservatively (80 of whom were operated on later). Group I patients were younger (P=.009), had more symptoms (P<.0001), and were more frequently in atrial fibrillation (P=.023) than group II patients. There was no difference in ejection fraction between the groups. The early surgery strategy was followed by an improved overall survival rate (P=.028) and a lower incidence of cardiovascular deaths (P=.025), congestive heart failure (P=.046), and new chronic atrial fibrillation (P=.032), as confirmed by multivariate analysis (adjusted risk ratios of 0.31, 0.18, 0.38, and 0.05, respectively; all P<.02). Conclusions: In patients with mitral regurgitation due to flail leaflets, the strategy of early surgery versus conservative management is associated with an improved long-term survival rate, decreased cardiac mortality, and decreased morbidity after diagnosis. This outcome advantage suggests that early surgery is a reasonable treatment option to be considered in low-risk candidates with repairable valves and severe mitral regurgitation.
KW - Echocardiography
KW - Heart failure
KW - Prognosis
KW - Valves
UR - http://www.scopus.com/inward/record.url?scp=0030770740&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030770740&partnerID=8YFLogxK
M3 - Article
C2 - 9323067
AN - SCOPUS:0030770740
VL - 96
SP - 1819
EP - 1825
JO - Circulation
JF - Circulation
SN - 0009-7322
IS - 6
ER -