Original articleAdult cardiacShould Patients With Severe Degenerative Mitral Regurgitation Delay Surgery Until Symptoms Develop?
Section snippets
Study Population
From January 1985 to January 2008, 4,586 patients underwent primary isolated surgery for MR caused by degenerative disease. Preoperative MR grade was assessed semiquantitatively by echocardiogram and was severe (grade 4) in 91% and moderately severe (grade 3) in 9%. Primary indication for surgery was MR in all patients; patients with coronary artery disease, aortic valve disease, hypertrophic cardiomyopathy, and ascending aortic aneurysm were excluded. Two hundred and fifty-seven patients
Preoperative Characteristics and NYHA Functional Class
Increasing functional class was associated with increasing age, female sex, greater comorbidity, and more structural and functional cardiac changes (Table 2). More symptomatic patients had more complex mitral valve pathology, with more valvar calcification and more anterior and bileaflet prolapse. Although left ventricular dimensions did not differ across functional classes (mean left ventricular end-systolic diameter was less than 40 mm in all groups), mean and median left ventricular ejection
Key Findings
Asymptomatic patients with severe degenerative MR can undergo surgery with low hospital mortality (0.3%) and a repair probability of 96%. These figures and long-term survival are similar in patients who have mild symptoms (NYHA functional class II). However, waiting until patients develop symptoms has a price. Development of even mild symptoms is associated with adverse changes in cardiac structure and function, including a slight decrease in left ventricular ejection fraction, left atrial
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