For years, cardiologists have debated about whether early surgical repair or watchful waiting is the better strategy for dealing with degenerative mitral regurgitation, a common heart valve problem that may produce no symptoms other than a heart murmur. Now, new research findings appearing today in JAMA indicate that early mitral valve surgery appears to be associated with greater long-term survival and a lower risk of heart failure than watchful waiting for a distinct event such as symptoms or indications of heart dysfunction before doing such surgery.
Researchers studied 575 patients with flail mitral valve regurgitation who were medically managed initially and 446 who underwent mitral valve surgery within 3 months after detection. These patients were enrolled in the Mitral Regurgitation International Database and received routine cardiac care from 6 tertiary centers in France, Italy, Belgium, and the United States. At 10 years’ follow-up, 86% of patients undergoing the early surgery were alive compared with 69% who were initially managed medically. Of those undergoing early surgery, 7% developed heart failure by year 10 compared with 23% of those who were medically managed.
Lead author Rakesh M. Suri, MD, DPhil, of the Mayo Clinic in Rochester, Minnesota, discusses his team’s findings.
news@JAMA: Who are these patients?
Dr Suri: These are patients you might see on the street who’ve been told they have a heart murmur but they feel well and are asymptomatic. They don’t have the typical triggers that would prompt surgery, such as having symptoms or heart dysfunction.
news@JAMA: Guideline writers have been ambivalent in endorsing this early surgery in patients who are asymptomatic. You support early surgery. Why?
Dr Suri: People have been hesitant because the surgery was not widely available. That has changed in the last decade and now we have surgeons with high levels of expertise who are performing a very safe and durable operation. The caveat I’d raise is that these should be performed within programs that are high-volume mitral valve programs.
news@JAMA: How onerous is the operation for patients?
Dr Suri: That is a rapidly shifting goalpost as these high-volume centers get better at performing the operation. Traditional valve repair operations will keep a patient in the hospital 7 days and get them back to work in 6 to 8 weeks. But for some patients who are candidates for minimally invasive valve repair, the procedure lasts about 4 to 6 hours, and we can get them out of the hospital in 3 days and back to work in 2 or 3 weeks.
news@JAMA: What would you tell patients with this type of mitral regurgitation who are considering their options?
Dr Suri: I’d like to get the message out there that degenerative mitral regurgitation is immensely treatable. With the right team performing the right operation without delay, that up-front investment of time and energy leads to important downstream benefits, including more years of life lived and more healthy years.