PMID- 25916875
OWN - NLM
STAT- MEDLINE
DCOM- 20150813
LR  - 20180119
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 99
IP  - 6
DP  - 2015 Jun
TI  - Increasing Disadvantage of "Watchful Waiting" for Repairing Degenerative Mitral 
      Valve Disease.
PG  - 1992-2000
LID - S0003-4975(15)00216-7 [pii]
LID - 10.1016/j.athoracsur.2015.01.065 [doi]
AB  - BACKGROUND: Successful durable repair of severe degenerative mitral regurgitation 
      with low operative mortality encourages intervention in asymptomatic patients 
      rather than "watchful waiting." Our objectives were to assess trends in patient 
      characteristics, timing of intervention, and evolving surgical techniques at a 
      high-volume center, and determine effects of these changes on outcomes after 
      mitral valve (MV) repair over a 25-year period. METHODS: From January 1, 1985, to 
      January 1, 2011, 5,902 patients underwent isolated repair (with or without 
      tricuspid repair for functional regurgitation) for degenerative MV disease at 
      Cleveland Clinic. For illustration, the experience is presented in 3 eras: 1985 
      to 1997 (era 1, n = 1,184), 1997 to 2005 (era 2, n = 2,400), and 2005 to 2011 
      (era 3, n = 2,318). RESULTS: In era 3, more patients were asymptomatic 
      on presentation (44% in New York Heart Association [NYHA] class I vs 25% in era 
      1), with less heart failure (11% vs 29%) and atrial fibrillation (9.9% vs 23%). 
      Full sternotomy decreased from era 1 (n = 1,100/93%) to era 2 (n = 602/25%) (era 
      3, n = 717/31%), and robotic surgery emerged (n = 577/25%) in era 3. Median 
      length of stay shortened (era 1 = 7 days, era 2 = 5.9 days, era 3 = 5.2 days, p < 
      0.0001), and in-hospital mortality remained low (era 1 = 5/0.42%, era 2 = 
      5/0.21%, era 3 = 1/0.043%); 0.73% overall required reoperation on the repaired 
      valve before discharge, and 97% had 0 to 1+ regurgitation at discharge. 
      CONCLUSIONS: Treatment trends over 25 years reveal that rather than watchful 
      waiting, a more aggressive approach to degenerative MV disease, with earlier 
      intervention for severe regurgitation in asymptomatic patients and less invasive 
      operative techniques, is successful, safe, and effective.
CI  - Copyright (c) 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Yazdchi, Farhang
AU  - Yazdchi F
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Koch, Colleen G
AU  - Koch CG
AD  - Department of Cardiothoracic Anesthesia, Heart and Vascular Institute, Cleveland 
      Clinic, Cleveland, Ohio.
FAU - Mihaljevic, Tomislav
AU  - Mihaljevic T
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Hachamovitch, Rory
AU  - Hachamovitch R
AD  - Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland 
      Clinic, Cleveland, Ohio.
FAU - Lowry, Ashley M
AU  - Lowry AM
AD  - Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, 
      Cleveland, Ohio.
FAU - He, Jiayan
AU  - He J
AD  - Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, 
      Cleveland, Ohio.
FAU - Gillinov, A Marc
AU  - Gillinov AM
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio.
FAU - Blackstone, Eugene H
AU  - Blackstone EH
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, 
      Research Institute, Cleveland Clinic, Cleveland, Ohio.
FAU - Sabik, Joseph F 3rd
AU  - Sabik JF 3rd
AD  - Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, 
      Cleveland Clinic, Cleveland, Ohio. Electronic address: sabikj@ccf.org.
LA  - eng
GR  - U01 HL088955/HL/NHLBI NIH HHS/United States
GR  - 1U01HL088955/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20150424
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
CIN - Ann Thorac Surg. 2015 Jun;99(6):2000. PMID: 26046858
MH  - Female
MH  - Follow-Up Studies
MH  - *Heart Valve Prosthesis Implantation
MH  - Hospital Mortality/trends
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve Insufficiency/mortality/*surgery
MH  - Ohio/epidemiology
MH  - Reoperation/trends
MH  - Retrospective Studies
MH  - Survival Rate/trends
MH  - Treatment Outcome
MH  - *Watchful Waiting
EDAT- 2015/04/29 06:00
MHDA- 2015/08/14 06:00
CRDT- 2015/04/29 06:00
PHST- 2014/08/21 00:00 [received]
PHST- 2015/01/14 00:00 [revised]
PHST- 2015/01/19 00:00 [accepted]
PHST- 2015/04/29 06:00 [entrez]
PHST- 2015/04/29 06:00 [pubmed]
PHST- 2015/08/14 06:00 [medline]
AID - S0003-4975(15)00216-7 [pii]
AID - 10.1016/j.athoracsur.2015.01.065 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2015 Jun;99(6):1992-2000. doi: 10.1016/j.athoracsur.2015.01.065. 
      Epub 2015 Apr 24.