Early surgery versus conventional treatment for asymptomatic severe mitral regurgitation: a propensity analysis.
OBJECTIVE
This study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation (MR).


BACKGROUND
The timing of surgery in asymptomatic severe MR remains controversial.


METHODS
From 1996 to 2009, 610 consecutive asymptomatic patients (364 men, 50 ± 14 years of age) with severe degenerative MR and preserved left ventricular function were evaluated prospectively. Early surgery was performed on 235 patients, and the conventional treatment strategy was chosen for 375 patients. We compared overall mortality, cardiac mortality, and cardiac events (operative mortality, cardiac mortality, repeat surgery, and urgent admission due to heart failure) between the 2 treatment strategies in the propensity score-matched cohort.


RESULTS
For the 207 propensity score-matched pairs, early surgery had a lower risk of cardiac mortality (hazard ratio [HR]: 0.109; 95% confidence interval [CI]: 0.014 to 0.836; p = 0.033) and cardiac events (HR: 0.216; 95% CI: 0.083 to 0.558; p = 0.002) than conventional treatment. On Cox proportional hazard model analysis, the risk of cardiac events was significantly lower in the early surgery group than in the conventional treatment group in patients aged 50 years of age and older (HR: 0.221; 95% CI: 0.086 to 0.567; p = 0.002), but not significantly different in those younger than 50 years of age (p = 0.20).


CONCLUSIONS
Compared with conservative management, early surgery is associated with significant long-term reductions of cardiac mortality and cardiac events in asymptomatic severe MR. These benefits were evident among patients age 50 years of age and older.
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea. Electronic address: dhkang@amc.seoul.kr.
Duk-Hyun
DH
Kang
Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Sung-Ji
SJ
Park
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Byung Joo
BJ
Sun
Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eun Jeong
EJ
Cho
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Dae-Hee
DH
Kim
Division of Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Sung-Cheol
SC
Yun
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Jong-Min
JM
Song
Division of Cardiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Seung Woo
SW
Park
Division of Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Cheol-Hyun
CH
Chung
Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Jae-Kwan
JK
Song
Division of Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea.
Jae-Won
JW
Lee
Division of Cardiac Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Pyo-Won
PW
Park
D058070:Asymptomatic Diseases / Q000628:therapy*; D061345:Early Medical Intervention; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000601:surgery / Q000628:therapy*; D057216:Propensity Score; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
echocardiography; mitral valve; regurgitation; surgery