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Mitral valve disease
Original research article
Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly
  1. Duk-Hyun Kang1,
  2. Ran Heo1,
  3. Sahmin Lee1,
  4. Seunghee Baek2,
  5. Dae-Hee Kim1,
  6. Jong-Min Song1,
  7. Jae-Kwan Song1,
  8. Jae Won Lee3
  1. 1 Divisions of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
  2. 2 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
  3. 3 Department of Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Republic of Korea
  1. Correspondence to Dr Duk-Hyun Kang, Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul 05505, Korea; dhkang{at}amc.seoul.kr

Abstract

Objective In elderly patients, the benefit of surgical correction of severe mitral regurgitation (MR) may not be greater than the operative risk. This study sought to compare the long-term clinical outcomes between initial surgery and conservative management in elderly patients (≥70 years of age) with severe MR.

Methods We prospectively evaluated 157 consecutive patients (75 men, 74±4 years of age) with severe degenerative MR and mild symptoms. Mitral valve surgery was performed on 79 (initial surgery group), whereas the conservative strategy was chosen for 78 patients (conservative management group). We compared the overall and cardiac mortality and cardiac event between strategies in the overall and propensity-matched cohort (46 pairs).

Results During the median follow-up of 5.4 years, overall death occurred less in the initial surgery group (16 vs 37 patients). This group showed reduced cardiac mortality (HR 0.31; 95% CI 0.13 to 0.73; p=0.007), overall mortality (HR 0.39; 95% CI 0.21 to 0.74; p=0.004) and cardiac event (HR 0.26; 95% CI 0.13 to 0.53; p<0.001). A significant reduction in cardiac mortality (HR 0.18; 95% CI 0.05 to 0.63; p=0.007), overall mortality (HR 0.36; 95% CI 0.15 to 0.86; p=0.022) and cardiac event (HR 0.20; 95% CI 0.07 to 0.52; p=0.001) in the initial surgery group was also observed in the propensity-matched cohort.

Conclusions In elderly patients with severe degenerative MR and mild symptoms, initial surgical strategy was associated with significant long-term reductions in cardiac and overall mortality compared with conservative management.

  • mitral regurgitation
  • valve disease surgery

http://dx.doi.org/10.1136/heartjnl-2017-311759

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    Footnotes

    • D-HK and RH contributed equally.

    • Contributors Dr D-HK had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: D-HK. Analysis and interpretation of data: D-HK, RH, SL, SB. Drafting of the manuscript: D-HK, RH. Critical revision of the manuscript for important intellectual content: D-HK, J-MS, J-KS, JWL. Final approval of manuscript: D-HK, RH, SL, SB, D-HK, J-MS, J-KS, J-WL.

    • Competing interests None declared.

    • Ethics approval Institutional Review Board of Asan Medical Center.

    • Provenance and peer review Not commissioned; externally peer reviewed.