title: Early surgery for asymptomatic mitral regurgitation: importance of atrial fibrillation.
abstract: OBJECTIVE
  It remains controversial whether early mitral valve (MV) repair should be performed for severe degenerative mitral regurgitation (MR) without symptoms, left ventricular (LV) dilatation or dysfunction, atrial fibrillation (AF) or pulmonary artery hypertension (PH), even at experienced surgical centers. The study aim was to reconsider the optimal timing of intervention for asymptomatic patients with severe degenerative MR at experienced surgical centers.
  
  
  METHODS
  Clinical outcomes were reviewed retrospectively for 298 consecutive asymptomatic patients (mean age 57 +/- 12 years) who underwent MV surgery for degenerative MR. The patients were allocated to two groups based on the following comorbid conditions: LVEF < or = 60%, LV end-systolic dimension 40 mm, AF, and PH. Group A comprised 122 patients with none of these conditions, while group B comprised 176 patients with any one of the conditions. The clinical outcomes were compared between the two groups at a mean of 7.0 +/- 4.5 years after surgery.
  
  
  RESULTS
  MV repair had been attempted in all patients, with a success rate of 100%. At 10 years, survival among group B patients was poorer than in group A (93% and 81%, respectively; p = 0.02), and there was a lower freedom from valve-related events (89% and 71%, respectively; p < 0.01). The independent predictors of valve-related events were preoperative AF (hazard ratio 3.34; p < 0.001) and age > 60 years (hazard ratio 2.50; p < 0.01).
  
  
  CONCLUSIONS
  Early MV repair is a reasonable option in asymptomatic patients, while preoperative AF may be a more appropriate predictor of an adverse outcome than LV function, as is currently recommended.
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. t-kitai@kcho.jp
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.forename: Yukikatsu
authors.initials: Y
authors.lastname: Okada
authors.forename: Yu
authors.initials: Y
authors.lastname: Shomura
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Tanabe
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tani
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
mesh_terms: D000367:Age Factors; D000368:Aged; D058070:Asymptomatic Diseases; D001281:Atrial Fibrillation / Q000209:etiology; D061345:Early Medical Intervention; D015150:Echocardiography, Doppler; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D058386:Mitral Valve Annuloplasty / Q000379:methods* / Q000706:statistics & numerical data; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000209:etiology; D016277:Ventricular Function, Left