title: Early surgery in patients with mitral regurgitation due to flail leaflets: a long-term outcome study.
abstract: BACKGROUND
  The optimal timing for surgery in patients with mitral regurgitation is disputed. Because of the frequency of left ventricular dysfunction, which is difficult to predict, early surgery has been recommended, but its potential benefits have not been demonstrated.
  
  
  RESULTS
  The outcomes of 221 patients (mean age, 65 +/- 13 years; 71% males) with flail leaflets diagnosed with two-dimensional echocardiography between 1980 and 1989 who were eligible for operation were analyzed. Group I comprised 63 patients who had early mitral valve surgery (within 1 month after diagnosis). Group II comprised 158 patients initially treated conservatively (80 of whom were operated on later). Group I patients were younger (P=.009), had more symptoms (P<.0001), and were more frequently in atrial fibrillation (P=.023) than group II patients. There was no difference in ejection fraction between the groups. The early surgery strategy was followed by an improved overall survival rate (P=.028) and a lower incidence of cardiovascular deaths (P=.025), congestive heart failure (P=.046), and new chronic atrial fibrillation (P=.032), as confirmed by multivariate analysis (adjusted risk ratios of 0.31, 0.18, 0.38, and 0.05, respectively; all P<.02).
  
  
  CONCLUSIONS
  In patients with mitral regurgitation due to flail leaflets, the strategy of early surgery versus conservative management is associated with an improved long-term survival rate, decreased cardiac mortality, and decreased morbidity after diagnosis. This outcome advantage suggests that early surgery is a reasonable treatment option to be considered in low-risk candidates with repairable valves and severe mitral regurgitation.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minn 55905, USA.
authors.forename: L H
authors.initials: LH
authors.lastname: Ling
authors.forename: M
authors.initials: M
authors.lastname: Enriquez-Sarano
authors.forename: J B
authors.initials: JB
authors.lastname: Seward
authors.forename: T A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: H V
authors.initials: HV
authors.lastname: Schaff
authors.forename: K R
authors.initials: KR
authors.lastname: Bailey
authors.forename: A J
authors.initials: AJ
authors.lastname: Tajik
authors.forename: R L
authors.initials: RL
authors.lastname: Frye
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D004452:Echocardiography; D004696:Endocarditis / Q000209:etiology / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome