Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: A propensity score–based comparison between an early surgical strategy and a conservative treatment approach
Received 19 May 2008; received in revised form 27 February 2009; accepted 29 March 2009. published online 29 June 2009.
Aims
The management of asymptomatic severe mitral regurgitation remains controversial. The aim of the study was to assess the long-term survival, incidence of cardiac complications, factors that predict outcome, and effect of mitral surgery on the long-term prognosis of patients with asymptomatic severe mitral regurgitation amenable to valve repair.
Methods
One hundred ninety-two asymptomatic patients (mean age, 63 ± 13 years) with severe degenerative mitral regurgitation diagnosed by 2-dimensional echocardiography between 1990 and 2001 were prospectively followed for a median of 8.5 years.
Results
Overall, cardiovascular, and event-free survival was evaluated in 2 groups of patients: a “conservative approach” group (n = 67) and an “early surgery” group (n = 125). Outcomes were also analyzed among patients with atrial fibrillation, pulmonary hypertension, or both, as well as in patients free of any mitral regurgitation complications. In the whole population, 10-year overall survival was significantly lower with the conservative approach than early surgery (50% ± 7% vs 86% ± 4%, log-rank < 0.0001). Similar results were obtained in the subgroups with atrial fibrillation and/or pulmonary hypertension. The 10-year propensity-matched score-adjusted hazards ratio for overall mortality, cardiac mortality, and cardiovascular events for the conservative treatment were 5.21, 4.83, and 4.40, respectively.
Conclusion
Our results show that the outcome of asymptomatic patients with severe degenerative mitral regurgitation is better with an early surgical approach rather than a more conservative treatment strategy.
aDivision of Cardiology, Cliniques Universitaires, St-Luc, Université Catholique de Louvain, Brussels, Belgium
bEpidemiology and Biostatistics Unit, Université Catholique de Louvain, Brussels, Belgium
Address for reprints: Jean-Louis Vanoverschelde, MD, PhD, Division of Cardiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10-2881, B-1200 Brussels, Belgium.
Supported by the Fonds National de la Recherche Scientifique of the Belgian Government (FNRS). Dr Montant is aspirant of the Fonds National de la Recherche Scientifique of the Belgian Government. Dr Chenot was supported by the Daman Foundation.
ABSTRACT