Patients with severe mitral regurgitation showed significantly better survival rates after early surgery, compared with a "watchful waiting" approach, according to a study published this week in the Journal of the American Medical Assn.
A severe defect of the heart’s mitral valve leaflets, called flail mitral valve regurgitation, is difficult for cardiologists to treat because of the unknown long-term consequences and notoriously "imperfect evidence," according to an editorial by echocardiologist Dr. Catherine Otto that accompanied the study.
The study answered some long-held clinical questions about the appropriate option for this patient group – mitral valve repair surgery or drug management/observation (watchful waiting). To answer this question, more than 1,000 patients at 6 medical centers across the globe were treated, then followed for 10 years.
Within 3 months of initial treatment, early mitral valve surgery fared no better than traditional watchful waiting. But the 10-year follow-up revealed significantly higher survival rates for surgery patients. Long-term survival rates were 86% for patients treated with surgery, versus 69% for the watchful waiting cohort.
Five years after surgery, a patient’s risk of death dropped more than 50%. At the 5-year follow-up, 95% of surgery patients had survived, versus 84% of the medically managed patients.