PMID- 33419544
OWN - NLM
STAT- MEDLINE
DCOM- 20210405
LR  - 20210405
IS  - 1097-685X (Electronic)
IS  - 0022-5223 (Linking)
VI  - 161
IP  - 3
DP  - 2021 Mar
TI  - Asymptomatic degenerative mitral regurgitation repair: Validating guidelines for 
      early intervention.
PG  - 981-994.e5
LID - S0022-5223(20)33153-6 [pii]
LID - 10.1016/j.jtcvs.2020.11.076 [doi]
AB  - INTRODUCTION: Mitral repair for asymptomatic (New York Heart Association [NYHA] 
      class I) degenerative mitral regurgitation (MR) is supported by the guidelines, 
      but is not performed often. We sought to determine outcomes for asymptomatic 
      patients when compared with those with symptoms. METHODS: Between 2004 and 2018, 
      1027 patients underwent mitral replacement (22) or repair with or without other 
      cardiac surgery (1005), the latter being grouped by NYHA class: I (n = 470; 47%), 
      II (n = 408; 40%), or III/IV (n = 127; 13%). Statistical analyses included 
      propensity score matching and weighting, and multistate models. RESULTS: The 
      proportion of patients designated as NYHA class I undergoing surgery increased 
      steadily during this period (P < .001). Overall, 30-day mortality was 0.4%, and 
      zero for patients designated NYHA class I. Unadjusted 10-year survival was 
      significantly greater in patients designated NYHA class I compared with II and 
      III/IV (P < .001). Freedom from reoperation at 10 years was 99.8% overall, and 
      100% for patients designated NYHA class I. In patients designated as NYHA class 
      I, predischarge and 10-year moderate MR were 0.7% and 20.1%, whereas more than 
      moderate was zero and 0.6%. Preoperative ejection fraction less than 60% was 
      associated with late mortality (P = .025). After covariate-adjustments, freedom 
      from MR and tricuspid regurgitation were not statistically significantly 
      different by NYHA class. However, overall survival was significantly worse in 
      patients with NYHA class III/IV, compared with class II. CONCLUSIONS: Mitral 
      repair in asymptomatic patients is safe and durable. Careful monitoring until 
      class II symptoms is appropriate. However, repair before ejection fraction 
      decreases below 60% is important for late overall survival.
CI  - Copyright (c) 2020 The American Association for Thoracic Surgery. Published by 
      Elsevier Inc. All rights reserved.
FAU - Desai, Anand
AU  - Desai A
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine 
      and Northwestern Memorial Hospital, Chicago, Ill.
FAU - Thomas, James D
AU  - Thomas JD
AD  - Division of Cardiology, Northwestern University Feinberg School of Medicine and 
      Northwestern Memorial Hospital, Chicago, Ill.
FAU - Bonow, Robert O
AU  - Bonow RO
AD  - Division of Cardiology, Northwestern University Feinberg School of Medicine and 
      Northwestern Memorial Hospital, Chicago, Ill.
FAU - Kruse, Jane
AU  - Kruse J
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine 
      and Northwestern Memorial Hospital, Chicago, Ill.
FAU - Andrei, Adin-Cristian
AU  - Andrei AC
AD  - Division of Biostatistics, Department of Preventive Medicine, Northwestern 
      University, Chicago, Ill.
FAU - Cox, James L
AU  - Cox JL
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine 
      and Northwestern Memorial Hospital, Chicago, Ill.
FAU - McCarthy, Patrick M
AU  - McCarthy PM
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine 
      and Northwestern Memorial Hospital, Chicago, Ill. Electronic address: 
      Patrick.McCarthy@nm.org.
LA  - eng
PT  - Journal Article
PT  - Webcast
DEP - 20201130
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
CIN - J Thorac Cardiovasc Surg. 2021 Mar;161(3):995-996. PMID: 33461805
MH  - Aged
MH  - Asymptomatic Diseases
MH  - Clinical Decision-Making
MH  - Databases, Factual
MH  - Female
MH  - Heart Valve Prosthesis
MH  - Heart Valve Prosthesis Implantation/adverse 
      effects/instrumentation/mortality/*standards
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/diagnostic imaging/physiopathology/*surgery
MH  - Mitral Valve Insufficiency/diagnostic imaging/mortality/physiopathology/*surgery
MH  - Practice Guidelines as Topic/*standards
MH  - Recurrence
MH  - Reoperation
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - New York Heart Association
OT  - atrial fibrillation
OT  - guidelines
OT  - mitral regurgitation
OT  - mitral valve
OT  - tricuspid regurgitation
EDAT- 2021/01/10 06:00
MHDA- 2021/04/07 06:00
CRDT- 2021/01/09 05:28
PHST- 2020/05/30 00:00 [received]
PHST- 2020/11/18 00:00 [revised]
PHST- 2020/11/19 00:00 [accepted]
PHST- 2021/01/10 06:00 [pubmed]
PHST- 2021/04/07 06:00 [medline]
PHST- 2021/01/09 05:28 [entrez]
AID - S0022-5223(20)33153-6 [pii]
AID - 10.1016/j.jtcvs.2020.11.076 [doi]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 2021 Mar;161(3):981-994.e5. doi: 
      10.1016/j.jtcvs.2020.11.076. Epub 2020 Nov 30.