Author + information
- Kee–Joon Choi,
- Jeong Yoon Jang,
- Byung Joo Sun,
- Dae–Hee Kim,
- Jong–Min Song,
- Jae–Kwan Song,
- Jae–Won Lee,
- Joo–Hee Zo and
- Duk–Hyun Kang
The optimal timing of surgery in asymptomatic patients with severe degenerative mitral regurgitation (MR) is unclear. We tried to compare the long–term outcomes of early surgery and conventional treatment using a propensity analysis.
We prospectively evaluated 671 consecutive, asymptomatic pts (413 men, age; 49±15 years) with severe degenerative MR and preserved left ventricular function between 1996 and 2009. Early surgery was chosen for 242 pts (OP group), and conventional treatment for 429 pts (CONV group). We compared the occurrences of composite end point of operative mortality, cardiac death, repeat surgery and urgent admission due to heart failure in the propensity–matched cohort and in prespecified subgroups according to age and effective regurgitant orifice area (ERO).
For the 194 propensity–score matched pairs, early surgery was associated with significantly lower risk of cardiac events (HR, 0.22; P=0.003). The actuarial 10–year event–free survival rates were also significantly different in pts aged > 50 years (92±4% in the OP group vs. 73±5% in the CONV group, P<0.001) (figure) or those with ERO ≥ 0.40 cm2(95±3% vs. 87±3%, P=0.001), but not different in those aged ≤ 50 years (P=0.26) or with ERO < 0.40 cm2(P=0.15).
Compared with CONV group, early surgery is associated with improved long–term outcomes in a propensity analysis. The reduction in cardiac events was particularly evident among patients aged > 50 years or those with ERO ≥0.40cm2.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.–10:45 a.m.
Session Title: Evolving Concepts for the Optimal Management of Mitral Regurgitation from E–Clip to Robotics
Abstract Category: 32. Valvular Heart Disease: Therapy
Presentation Number: 1111–75
- 2013 American College of Cardiology Foundation