Early surgery linked to better long-term outcomes in asymptomatic severe mitral regurgitation

Timing of surgery appears to influence long-term outcomes in asymptomatic severe mitral regurgitation, such that performing the surgery early leads to better results over the long term than waiting until symptoms develop, according to a study.

The study included 1,063 consecutive asymptomatic patients (mean age 51 years, 63.3 percent male) with severe degenerative mitral regurgitation and preserved left ventricular function. Of these, 545 underwent early surgery (within 6 months of enrolment) and 518 underwent watchful waiting (conventional management), only being referred for surgery in the event of symptom development or other class I or II operative triggers. Treatment assignment was based on shared decision-making between physicians and patients, and all patients were followed prospectively for a median of 12 years.

Propensity score adjustment was applied to compare overall and cardiac mortality rates between the early surgery and conventional management groups.

No operative deaths occurred in the early surgery group, and mitral valve was repaired successfully in 97 percent of patients.

During the follow-up, significantly fewer patients in the early surgery group than in the conventional management group died from cardiovascular causes (1.5 percent vs 10.4 percent; hazard ratio [HR], 0.17, 95 percent confidence interval [CI], 0.07–0.40; p<0.001). Similarly, deaths from any cause occurred less in the early surgery group than in the conventional management group (13.6 percent vs 22.4 percent; HR, 0.72, 95 percent CI, 0.52–0.99; p=0.046).

Results were similar in the propensity-score matched cohort of 358 pairs of patients. Compared with the conventional management, early surgery was associated with significantly lower risks of cardiac mortality (HR, 0.18, 95 percent CI, 0.08–0.43; p<0.001) and overall mortality (HR, 0.66, 95 percent CI, 0.47–0.93; p=0.018). At 20 years, the early surgery group had significantly lower rates of cardiac mortality rates (5.6 percent vs 17.4 percent; p=0.002) and overall mortality (28.2 percent vs 33.9 percent; p=0.015).