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J Thorac Cardiovasc Surg 2009;138:1339-1348
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Long-term survival in asymptomatic patients with severe degenerative mitral regurgitation: A propensity score–based comparison between an early surgical strategy and a conservative treatment approach

^a Division of Cardiology, Cliniques Universitaires, St-Luc, Université Catholique de Louvain, Brussels, Belgium
^b Epidemiology and Biostatistics Unit, Université Catholique de Louvain, Brussels, Belgium

Received for publication May 19, 2008; revisions received February 27, 2009; accepted for publication March 29, 2009.

^_* Address for reprints: Jean-Louis Vanoverschelde, MD, PhD, Division of Cardiology, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10-2881, B-1200 Brussels, Belgium. (Email: vanoverschelde{at}card.ucl.ac.be).

Aims: The management of asymptomatic severe mitral regurgitation remains controversial. The aim of the study was to assess the long-term survival, incidence of cardiac complications, factors that predict outcome, and effect of mitral surgery on the long-term prognosis of patients with asymptomatic severe mitral regurgitation amenable to valve repair.

Methods: One hundred ninety-two asymptomatic patients (mean age, 63 ± 13 years) with severe degenerative mitral regurgitation diagnosed by 2-dimensional echocardiography between 1990 and 2001 were prospectively followed for a median of 8.5 years.

Results: Overall, cardiovascular, and event-free survival was evaluated in 2 groups of patients: a "conservative approach" group (n = 67) and an "early surgery" group (n = 125). Outcomes were also analyzed among patients with atrial fibrillation, pulmonary hypertension, or both, as well as in patients free of any mitral regurgitation complications. In the whole population, 10-year overall survival was significantly lower with the conservative approach than early surgery (50% ± 7% vs 86% ± 4%, log-rank < 0.0001). Similar results were obtained in the subgroups with atrial fibrillation and/or pulmonary hypertension. The 10-year propensity-matched score-adjusted hazards ratio for overall mortality, cardiac mortality, and cardiovascular events for the conservative treatment were 5.21, 4.83, and 4.40, respectively.

Conclusion: Our results show that the outcome of asymptomatic patients with severe degenerative mitral regurgitation is better with an early surgical approach rather than a more conservative treatment strategy.

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