Early surgery in patients with mitral regurgitation due to flail leaflets: A long-term outcome study

Lieng H. Ling, Maurice E Sarano, James B. Seward, Thomas A. Orszulak, Hartzell V Schaff, Kent R Bailey, A. Jamil Tajik, Robert L. Frye

Research output: Contribution to journalArticle

200 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1819-1825
Number of pages7
JournalCirculation
Volume96
Issue number6
StatePublished - Sep 16 1997

Fingerprint

Mitral Valve Insufficiency
Outcome Assessment (Health Care)
Atrial Fibrillation
Survival Rate
Left Ventricular Dysfunction
Mitral Valve
Echocardiography
Multivariate Analysis
Heart Failure
Odds Ratio
Morbidity
Mortality
Incidence

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 journalArticle

Ling, LH, Sarano, ME, Seward, JB, Orszulak, TA, Schaff, HV, Bailey, KR, Tajik, AJ & Frye, RL 1997, 'Early surgery in patients with mitral regurgitation due to flail leaflets: A long-term outcome study', Circulation, vol. 96, no. 6, pp. 1819-1825.
Ling, Lieng H. ; Sarano, Maurice E ; Seward, James B. ; Orszulak, Thomas A. ; Schaff, Hartzell V ; Bailey, Kent R ; Tajik, A. Jamil ; Frye, Robert L. / Early surgery in patients with mitral regurgitation due to flail leaflets : A long-term outcome study. In: Circulation. 1997 ; Vol. 96, No. 6. pp. 1819-1825.
@article{4911d154277f4d11bbd6ea19ab196b83,
title = "Early surgery in patients with mitral regurgitation due to flail leaflets: A long-term outcome study",
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.",
keywords = "Echocardiography, Heart failure, Prognosis, Valves",
author = "Ling, {Lieng H.} and Sarano, {Maurice E} and Seward, {James B.} and Orszulak, {Thomas A.} and Schaff, {Hartzell V} and Bailey, {Kent R} and Tajik, {A. Jamil} and Frye, {Robert L.}",
year = "1997",
month = "9",
day = "16",
language = "English (US)",
volume = "96",
pages = "1819--1825",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

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 -