Mitral valve surgery for heart failure: a failed innovation?

Five million Americans suffer from heart failure. Despite innovative new pharmacologic and device therapy, the 5-year mortality rate for these patients remains near 50%. Conservatively, 300,000 patients with heart failure also have severe functional mitral regurgitation. Over the past decade the surgical approach to these patients has become more aggressive as the extent of the problem has become widely recognized and surgeon familiarity with annuloplasty techniques has increased. There are, however, few data to support that such interventions improve longevity, reduce heart size, or limit symptoms. In fact the best available data support the conclusion that surgery for functional mitral regurgitation has no effect on survival. We present a review of the existing data on the efficacy of mitral valve surgery in heart failure patients. These data are sobering but confirm the need for evidence-based decision-making in cardiac surgery no matter how intuitively beneficial a procedure may initially seem.