Abstract 12905: Initial Surgery Versus Conservative Management for Elderly Patients With Symptomatic Severe Mitral Regurgitation
Background: The benefit of surgical correction of severe mitral regurgitation (MR) may not be greater than operative risk in elderly patients without significant symptoms. This study sought to compare long-term survival between initial surgery and conservative management in elderly patients (≥ 70 years of age) with mild symptoms and severe MR.
Methods: From 1996 to 2014, we prospectively evaluated 157 consecutive elderly patients (75 men, 74 ± 4 years of age) with severe degenerative MR who have dyspnea of NYHA functional class II. Mitral valve (MV) surgery was performed on 79 patients (OP group) within 3 months of the initial evaluation and the conservative strategy was chosen for 78 patients (conservative group). Follow-up data were obtained until April 2016, and the primary end-point was occurrence of cardiac death and the secondary end-point was death from any cause.
Methods: In the OP group, operative mortality was 1.3%, and MV repair and replacement were performed in 64 (81%) and 15 (19%) patients, respectively, and 8 (10%) patients underwent late MV surgery in the conservative group. The risk of cardiac mortality was significantly lower in the OP group (HR 0.32; 95% CI, 0.14 to 0.75; P = 0.008), and the estimated actuarial 10-year cardiac mortality rates were 11 ± 5% in the OP group and 45 ± 8% in the conservative group (Figure). The risk of all-cause mortality was also significantly lower in the OP group (HR 0.39; 95% CI, 0.21 to 0.74; P = 0.004). Conservative strategy was independently associated with cardiac mortality (HR 0.34; 95% CI, 0.14 to 0.81; P = 0.016) and overall mortality (HR 0.41; 95% CI, 0.21 to 0.79; P = 0.008) in the Cox proportional hazards analysis adjusted for age and STS score.
Conclusions: Compared with conservative management, initial surgical strategy for severe MR is associated with significant long-term reductions of overall mortality and cardiac mortality in elderly patients without significant symptoms.
Author Disclosures: R. Heo: None. D. Kang: None. S. Lee: None. D. Kim: None. J. Song: None. K. Choi: None. J. Song: None. J. Lee: None. J. Zo: None.
- © 2016 by American Heart Association, Inc.