Surgery for asymptomatic degenerative aortic and mitral valve disease

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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
08:50

Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement

Published on: March 26, 2018

Prashant Vaishnava1, Valentin Fuster, Martin Goldman

  • 1Zena and Michael A. Wiener Cardiovascular Institute, Marie-Jose and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, New York, NY 10029, USA. prashant.vaishnava@mountsinai.org

Nature Reviews. Cardiology
|January 19, 2011
PubMed

Insights

Early intervention for asymptomatic aortic stenosis (AS) or mitral regurgitation (MR) may be beneficial. This approach considers new data on surgical outcomes and disease progression in degenerative valvular heart disease.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Degenerative valvular heart disease is the most prevalent valve condition in Western populations.
  • Current guidelines recommend surgery for symptomatic patients or those with impaired left ventricular function.
  • The optimal timing for surgical intervention in asymptomatic patients with aortic stenosis (AS) or mitral regurgitation (MR) is debated.

Purpose of the Study:

  • To advocate for early, pre-emptive surgical intervention in carefully selected asymptomatic patients with AS or MR.
  • To support this argument using current perioperative data, disease progression predictors, and natural history studies.

Main Methods:

  • Review of contemporary perioperative outcomes.
  • Analysis of predictors for disease progression in degenerative valvular heart disease.
  • Examination of the natural history of valvular heart disease.

Main Results:

  • Contemporary data suggest favorable outcomes for early intervention.
  • Identified key predictors of disease progression in AS and MR.
  • Natural history studies highlight risks associated with delayed intervention.

Conclusions:

  • Early surgical intervention should be considered for select asymptomatic patients with AS or MR.
  • This strategy may improve long-term outcomes compared to watchful waiting.
  • Further research and guideline refinement are warranted to support pre-emptive surgical management.

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