| What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? | |
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MedLine Citation:
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PMID: 17350971 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: To identify the proportion and characteristics of patients with severe symptomatic mitral regurgitation (MR) who are denied surgery. METHODS AND RESULTS: In the Euro Heart Survey on valvular heart disease, 396 patients had severe symptomatic MR as assessed by Doppler-echocardiography (grade > or =3/4) and New York Heart Association class II or greater. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 193 patients (49%). In multivariable analysis, decreased left ventricular ejection fraction (LVEF) [OR = 1.39 per 10% decrease, 95% CI (1.17-1.66), P = 0.0002], non-ischaemic aetiology [OR = 4.44, 95% CI (1.96-10.76), P = 0.0006], older age [OR = 1.40 per 10-year increase, 95% CI (1.15-1.72), P = 0.001], increased Charlson comorbidity index [OR = 1.38 per 1 point increase, 95% CI (1.12-1.72), P = 0.004], and grade 3 MR [OR = 2.23, 95% CI (1.28-3.29), P = 0.005] were associated with the decision not to operate. One-year survival was 96.0 +/- 1.4% in patients with a positive decision for intervention vs. 89.5 +/- 2.3% in those with a negative decision (P = 0.02). CONCLUSION: Surgery was denied in 49% of patients with severe symptomatic MR. Impaired LVEF, older age, and comorbidity were the most striking characteristics of patients who were denied surgery. The weight of age and LVEF in the decision do not seem justified according to current knowledge. |
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Authors:
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Mariana Mirabel; Bernard Iung; Gabriel Baron; David Messika-Zeitoun; Delphine Détaint; Jean-Louis Vanoverschelde; Eric G Butchart; Philippe Ravaud; Alec Vahanian |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2007-03-09 |
Journal Detail:
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Title: European heart journal Volume: 28 ISSN: 0195-668X ISO Abbreviation: Eur. Heart J. Publication Date: 2007 Jun |
Date Detail:
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Created Date: 2007-05-31 Completed Date: 2007-12-07 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8006263 Medline TA: Eur Heart J Country: England |
Other Details:
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Languages: eng Pagination: 1358-65 Citation Subset: IM |
Affiliation:
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Cardiology Department, Bichat Hospital, AP-HP, 46 rue Henri Huchard, 75018 Paris, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Age Factors Aged Aged, 80 and over Comorbidity Coronary Artery Bypass / statistics & numerical data Decision Making Female Follow-Up Studies Humans Male Middle Aged Mitral Valve Insufficiency / etiology, mortality, surgery* Referral and Consultation Refusal to Treat / statistics & numerical data* Regression Analysis Stroke Volume Survival Analysis Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Eur Heart J. 2007 Jun;28(11):1281-2
[PMID:
17493943
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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