Abstract 2260: Asymptomatic Patients with Severe Mitral Regurgitation and either Atrial Fibrillation or Pulmonary Hypertension Benefit from an Early Surgical Strategy
Background. Degenerative mitral regurgitation (MR) is the second most frequent valvular heart disease in industrialized countries. Although there is consensus that valvular surgery should be advised in symptomatic patients (pts) with severe MR and in those with reduced LV function, there is persisting controversy regarding the optimal timing of intervention in asymptomatic pts with only atrial fibrillation or pulmonary hypertension, as shown by the corresponding class IIa recommendation in the recent guidelines.
Methods. To test if asymptomatic pts with severe degenerative MR and either atrial fibrillation, pulmonary hypertension or both benefit from early surgery, the outcomes of 69 such pts (70 ± 12 years; 64% males) diagnosed by 2D-echo between 1990 and 2001 were analyzed. Pts with a LV ejection fraction below 60% or telesystolic diameter above 45 mm were not included. Group I comprised 46 pts undergoing mitral repair (within 3 months after diagnosis). Group II comprised 23 pts initially treated conservatively.
Results. During follow-up, 3 Group II pts needed mitral surgery. Indications for surgery were according to class I current guidelines. Adjusted 10-year overall survival was better in Group I than in Group II pts (74 ± 8%, 11 ± 7%, p<0.0001). Similarly, adjusted 10-year cardiac event free survival, including the need for (redo) surgery was better in Group I than in Group II pts (72 ± 7%, 10 ± 10%, p<0.0001).
Conclusion. Asymptomatic pts with severe MR complicated by either atrial fibrillation, pulmonary hypertension or both, clearly benefit from an early interventional strategy and should probably be operated on as soon as possible.