PMID- 20667334
OWN - NLM
STAT- MEDLINE
DCOM- 20100824
LR  - 20100729
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 90
IP  - 2
DP  - 2010 Aug
TI  - Should patients with severe degenerative mitral regurgitation delay surgery until 
      symptoms develop?
PG  - 481-8
LID - 10.1016/j.athoracsur.2010.03.101 [doi]
AB  - BACKGROUND: The American College of Cardiology/American Heart Association 
      practice guidelines recommending surgery for asymptomatic patients with severe 
      mitral regurgitation caused by degenerative disease remain controversial. This 
      study examined whether delaying surgery until symptoms occur causes adverse 
      cardiac changes and jeopardizes outcome. METHODS: From January 1985 to January 
      2008, 4,586 patients had primary isolated mitral valve surgery for degenerative 
      mitral regurgitation; 4,253 (93%) underwent repair. Preoperatively, 30% were in 
      New York Heart Association (NYHA) class I (asymptomatic), 56% in class II, 13% in 
      class III, and 2% in class IV. Multivariable analysis and propensity matching 
      were used to assess association of symptoms (NYHA class) with cardiac structure 
      and function and postoperative outcomes. RESULTS: Increasing NYHA class was 
      associated with progressive reduction in left ventricular function, left atrial 
      enlargement, and development of atrial fibrillation and tricuspid regurgitation. 
      These findings were evident even in class II patients (mild symptoms). Repair was 
      accomplished in 96% of asymptomatic patients, and in progressively fewer as NYHA 
      class increased (93%, 86%, and 85% in classes II to IV, respectively; p < 
      0.0001). Hospital mortality was 0.37%, but was particularly high in class IV 
      (0.29%, 0.20%, 0.67%, and 5.1% for classes I to IV, respectively; p = 0.004). 
      Although long-term survival progressively diminished with increasing NHYA class, 
      these differences were largely related to differences in left ventricular 
      function and increased comorbidity. CONCLUSIONS: In patients with severe 
      degenerative mitral regurgitation, the development of even mild symptoms by the 
      time of surgical referral is associated with deleterious changes in cardiac 
      structure and function. Therefore, particularly because successful repair is 
      highly likely, early surgery is justified in asymptomatic patients with 
      degenerative disease and severe mitral regurgitation.
CI  - Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Gillinov, A Marc
AU  - Gillinov AM
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland, OH 44195, USA. gillinom@ccf.org
FAU - Mihaljevic, Tomislav
AU  - Mihaljevic T
FAU - Blackstone, Eugene H
AU  - Blackstone EH
FAU - George, Kristopher
AU  - George K
FAU - Svensson, Lars G
AU  - Svensson LG
FAU - Nowicki, Edward R
AU  - Nowicki ER
FAU - Sabik, Joseph F 3rd
AU  - Sabik JF 3rd
FAU - Houghtaling, Penny L
AU  - Houghtaling PL
FAU - Griffin, Brian
AU  - Griffin B
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Female
MH  - Heart Diseases/etiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/complications/*diagnosis/*surgery
MH  - Prospective Studies
MH  - Severity of Illness Index
MH  - Time Factors
EDAT- 2010/07/30 06:00
MHDA- 2010/08/25 06:00
CRDT- 2010/07/30 06:00
PHST- 2010/01/11 00:00 [received]
PHST- 2010/03/11 00:00 [revised]
PHST- 2010/03/16 00:00 [accepted]
PHST- 2010/07/30 06:00 [entrez]
PHST- 2010/07/30 06:00 [pubmed]
PHST- 2010/08/25 06:00 [medline]
AID - S0003-4975(10)00746-0 [pii]
AID - 10.1016/j.athoracsur.2010.03.101 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2010 Aug;90(2):481-8. doi: 10.1016/j.athoracsur.2010.03.101.