This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by St. John Sutton, M. G. Articles by Gorman, R. C. Search for Related Content PubMed PubMed Citation Articles by St. John Sutton, M. G. Articles by Gorman, R. C. Related Collections Echocardiography CV surgery: valvular disease

(Circulation. 2006;114:258-260.)
© 2006 American Heart Association, Inc.

Editorial

Surgery for Asymptomatic Severe Mitral Regurgitation in the Elderly

Early Surgery or Wait and Watch?

Martin G. St. John Sutton, FRCP; Robert C. Gorman, MD

From the Division of Cardiology, University of Pennsylvania Medical Center, Philadelphia.

Correspondence to Martin St. John Sutton, FRCP, Divisions of Cardiology and Cardio-Thoracic Surgery, University of Pennsylvania Medical Center, 3400, Spruce Street, Philadelphia, PA 19104. E-mail suttonm@mail.med.upenn.edu

Key Words: Editorials • survival • mitral valve • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Cardiovascular disease is the major cause of death in subjects >75 years of age, a healthcare problem that will increase as the population continues to age. In the United States, the predicted population >75 years of age will exceed 50 million by the year 2038. Epidemiological studies have shown that the prevalence of mitral regurgitation (MR) also increases progressively with age; thus, MR is a common and growing problem in the elderly.¹ The most frequently encountered types of MR in the elderly are degenerative mitral valve disease, which results from primary floppy, myxomatous valves with prolapsing or flail leaflets and calcified mitral annulus, and ischemic MR (IMR), now that rheumatic mitral valve disease has declined and endocarditis remains comparatively rare.

Article p 265

Although there are American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the optimal management of a broad spectrum of patients with severe MR,² attention has not focused specifically on the elderly, in whom the condition predominates. In addition, operative mortality is increased in the elderly by major comorbidities that include coronary artery disease, cerebrovascular disease, heart failure, atrial fibrillation, and renal insufficiency. Furthermore, little is known regarding the difference in life expectancy and risk of adverse events in elderly patients with severe MR undergoing successful mitral valve surgery versus those who decline or are denied surgical intervention. A delicate balance must be struck in optimally managing elderly patients with severe MR that not only favors symptomatic benefit over perioperative risk of an adverse clinical outcome, but . . . [Full Text of this Article]

This article has been cited by other articles:

				F. Maisano, G. Vigano, C. Calabrese, M. Taramasso, P. Denti, A. Blasio, A. Guidotti, and O. Alfieri Quality of life of elderly patients following valve surgery for chronic organic mitral regurgitation Eur. J. Cardiothorac. Surg., August 1, 2009; 36(2): 261 - 266. [Abstract] [Full Text] [PDF]

				A. Vahanian, B. Iung, L. Piérard, R. Dion, and J. Pepper CHAPTER 21 Valvular Heart Disease ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				Should Elders with MR Undergo Surgery? Journal Watch Cardiology, August 30, 2006; 2006(830): 5 - 5. [Full Text]