Abstract 11443: Early Surgery ervsus Conventional Treatment in Asymptomatic Mitral Regurgitation: A Propensity Analysis
Background: The timing of surgery in asymptomatic patients with severe mitral regurgitation (MR) remains controversial due to lack of randomized trials. We therefore compared the long-term results of early surgery with conventional treatment strategy using a propensity analysis.
Methods: We prospectively evaluated 815 consecutive asymptomatic patients (430 men, age 47±15 years) with severe MR and preserved left ventricular function between 1996 and 2009. The causes of MR were degenerative in 671 patients, rheumatic in 138, and congenital in 6. Early surgery was performed on 290 patients (OP group) and the conventional treatment strategy was chosen for 525 patients (CONV group). We compared the rates of cardiac death and composite end point of operative mortality, cardiac death, repeat surgery, and urgent admission due to heart failure with the use of propensity-score matching in the overall cohort and in separate subgroups according to age.
Results: In the overall matched cohort of 242 pairs, the actuarial 10-year rates of cardiac mortality (1±1%) and composite end point (3±2%) in the OP group were significantly lower than those (7±2% and 15±3%) in the CONV group (P< 0.01). Early surgery was associated with reduced cardiac mortality (hazard ratio [HR], 0.09; P= 0.02) and reduced end point (HR, 0.09; P<0.01). In subgroup analysis according to age, the actuarial 10-year rates of cardiac mortality and composite end point (3±3% and 4±3%) in the OP group were significantly lower than those (16±5% and 33±6%) in the CONV group among patients aged > 50 years (P< 0.01), whereas there were no significant differences between the two groups among patients aged ≤ 50 years in terms of the actuarial rates of cardiac mortality and composite end point (P= NS) (figure).
Conclusions: Compared with conventional treatment, early surgery was associated with an improved outcome by decreasing cardiac mortality and events. The improved outcome was particularly evident among patients aged > 50 years.
- © 2012 by American Heart Association, Inc.