Abstract 2259: Should Asymptomatic Patients with Severe Uncomplicated Mitral Regurgitation Be Operated on Preventively or Followed-up Conservatively ?
Background. The management of asymptomatic patients (pts) with severe uncomplicated mitral regurgitation (MR) remains unclear. Indeed, recommendations have been made for both immediate surgery and conservative management, with referral to surgery when symptoms occur or pts develop complications (LV dysfunction or dilation, pulmonary hypertension or atrial fibrillation). Therefore, it is uncertain which of these 2 approaches should be preferred.
Methods. To test this, the outcomes of 141 asymptomatic pts (61 ± 14 years; 70% males) with severe uncomplicated degenerative MR diagnosed by 2D-echo between 1990 and 2001 were analyzed. Group I comprised 87 pts undergoing early mitral repair (within 3 months after diagnosis). Group II comprised 54 pts initially treated conservatively.
Results. During follow-up, 20 Group II pts needed mitral surgery. Indications for surgery were according to prevailing guidelines in 15, endocarditis in 3 and need for bypass surgery in 2. Adjusted 10-year overall survival was better in Group I than in Group II pts (90 ± 4%, 73 ± 7%, p<0.006). Similarly, adjusted 10-year cardiac event free survival, including the need for (redo) surgery was better in Group I than in Group II pts (75 ± 5%, 29 ± 7%, p<0.0001).
Conclusion. In asymptomatic pts with severe uncomplicated MR, an early surgical strategy appears to be superior to a more conservative approach. This suggest that early surgery should be the preferred treatment option in low-risk MR pts with repairable valves.