| Should patients with asymptomatic severe mitral regurgitation with good left ventricular function undergo surgical repair? | |
| | |
MedLine Citation:
|
PMID: 19933238 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, 'Does severe asymptomatic mitral regurgitation (MR) require surgery or is watch and wait the optimal strategy?'. Over 103 papers were found using the reported search, and 10 represented the best evidence to answer this clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. No studies in the modern era have shown significant survival benefit for patients undergoing surgery for asymptomatic severe MR if they have good left ventricular (LV) function. The progression rate to surgery on developing symptoms is 10% per year in these patients. Ling et al. reported a 63% incidence of congestive heart failure and 30% incidence of chronic atrial fibrillation (AF) at 10 years for conservative treatment, during which period 90% either underwent surgery or died. In addition, one study of 478 patients with good LV operated on in the 1980s showed a 76% 10-year survival in patients who were NYHA I/II but only a 48% 10-year survival in patients with NYHA III/IV although this group was older and had more AF. Early surgery has very good peri- and postoperative survival rates, and the American Heart Association currently recommend that these patients may be operated on if the chance of repair is >90%. Patients may, therefore, be reassured that either strategy is acceptable. |
| | |
Authors:
|
Peter Ogutu; Ishtiaq Ahmed; Joel Dunning |
Related Documents
:
|
20197348 - Open-heart surgery in an infant with heterozygous factor vii deficiency. 7212828 - A safe technique for removal of massive left atrial thrombus. 20470448 - Analysis of 8681 neonates with transposition of the great arteries: outcomes with and w... 18941608 - Ascites secondary to indolent pacemaker infection in a fontan patient. 16773978 - Vertebral body reconstruction for thoracolumbar spinal metastasis--a review of techniques. 2953038 - Transconjunctival lateral canthopexy in down's syndrome patients: a nonstigmatizing app... |
Publication Detail:
|
Type: In Vitro; Journal Article; Review Date: 2009-11-19 |
Journal Detail:
|
Title: Interactive cardiovascular and thoracic surgery Volume: 10 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2010 Feb |
Date Detail:
|
Created Date: 2010-01-21 Completed Date: 2010-03-29 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 101158399 Medline TA: Interact Cardiovasc Thorac Surg Country: England |
Other Details:
|
Languages: eng Pagination: 299-305 Citation Subset: IM |
Affiliation:
|
Department of Cardiothoracic Surgery, James Cook University Hospital, Marton Road, Cleveland, TS4 3BW, UK. p.ogutu@gmail.com |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Atrial Fibrillation / etiology, physiopathology, surgery Benchmarking Cardiac Surgical Procedures* / adverse effects, mortality Disease Progression Evidence-Based Medicine Female Heart Failure / etiology, physiopathology, surgery Humans Male Middle Aged Mitral Valve Insufficiency / complications, mortality, physiopathology, surgery* Patient Selection Practice Guidelines as Topic Risk Assessment Severity of Illness Index Time Factors Treatment Outcome Ventricular Function, Left* |
| Comments/Corrections | |
Comment In:
|
Interact Cardiovasc Thorac Surg. 2010 Feb;10(2):305
[PMID:
20089687
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: The EuroSCORE - still helpful in patients undergoing isolated aortic valve replacement?
Next Document: Repair of coronary artery perforation following angioplasty using TachoSil(R) patches.