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Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly

Duk-Hyun Kang1, Ran Heo1, Sahmin Lee1

  • 1Divisions of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea.

Heart (British Cardiac Society)
|October 7, 2017
PubMed
Abstract

Insights

For elderly patients with severe mitral regurgitation and mild symptoms, initial surgery significantly reduces long-term cardiac and overall mortality compared to conservative management.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Cardiac Surgery

Background:

  • Elderly patients with severe mitral regurgitation (MR) face a complex treatment decision due to potential high operative risks.
  • The comparative long-term benefits of surgical intervention versus conservative management in this demographic are not well-established.

Purpose of the Study:

  • To compare long-term clinical outcomes between initial surgical correction and conservative management for severe degenerative MR in patients aged 70 years and older.
  • To evaluate the impact of each strategy on overall and cardiac mortality, as well as cardiac events.

Main Methods:

  • A prospective evaluation of 157 consecutive patients (≥70 years) with severe degenerative MR and mild symptoms.
  • Patients were divided into an initial surgery group (n=79) and a conservative management group (n=78).
  • Outcomes were compared between groups, including an analysis of a propensity-matched cohort (46 pairs).

Main Results:

  • Over a median follow-up of 5.4 years, the initial surgery group experienced less overall death (16 vs 37).
  • Initial surgery was associated with significantly reduced cardiac mortality (HR 0.31), overall mortality (HR 0.39), and cardiac events (HR 0.26) compared to conservative management.
  • These benefits were also significant in the propensity-matched cohort, with reduced cardiac mortality (HR 0.18), overall mortality (HR 0.36), and cardiac events (HR 0.20).

Conclusions:

  • In elderly patients with severe degenerative MR and mild symptoms, an initial surgical strategy leads to significant long-term reductions in both cardiac and overall mortality.
  • Surgical intervention appears to be a more beneficial approach than conservative management for this patient population.
  • These findings support considering surgical correction for eligible elderly patients with severe MR.
Keywords:
mitral regurgitationvalve disease surgery

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