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.

Montant, Patrick;Chenot, Fabien;Robert, Annie;Vancraeynest, David;Vanoverschelde, Jean-Louis;et.al.
(2009) The Journal of Thoracic and Cardiovascular Surgery — Vol. 138, n° 6, p. 1339-1348 (2009)

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Abstract
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.
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Montant, P., Chenot, F., Robert, A., Vancraeynest, D., Pasquet, A., Gerber, B., Noirhomme, P., El Khoury, G., & Vanoverschelde, J.-L. (2009). 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. The Journal of Thoracic and Cardiovascular Surgery, 138(6), 1339-1348. https://doi.org/10.1016/j.jtcvs.2009.03.046 (Original work published 2009)