Early Surgery Beneficial for Asymptomatic Severe Mitral Regurgitation

For patients at low risk for operative complications, surgical intervention can be a better strategy than watchful waiting.

Controversy surrounds the timing of surgical intervention for asymptomatic severe mitral regurgitation (MR) with preserved LV systolic function. These investigators compared early surgery (within 6 months of diagnosis) with a watchful-waiting approach in 447 patients (mean age, 50) with severe degenerative MR due to prolapse, flail leaflet, or both who were enrolled in a prospective registry. Patients with LV ejection fractions ≤60%, LV end-systolic diameters >45 mm, atrial fibrillation, or severe pulmonary hypertension were excluded. Surgery was recommended at the attending physician’s discretion. Early surgery was performed on 161 patients (94%, repair; 6%, replacement); 286 patients received conventional therapy (watchful waiting).

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Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI