Early Surgery or Watchful Waiting for Asymptomatic Severe Degenerative Mitral Regurgitation

After decades of study, the appropriate strategy for managing asymptomatic patients with severe mitral regurgitation (MR) remains controversial. Because no randomized, controlled trials (RCTs) have been performed, current "practice guidelines" are based on inferences drawn from comparison...

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Bibliographic Details
Published inJournal of the American College of Cardiology Vol. 63; no. 22; pp. 2408 - 2410
Main Author Borer, Jeffrey S., MD
Format Journal Article
LanguageEnglish
Published New York Elsevier Limited 10.06.2014
Subjects
Bias
Cardiology
Cardiovascular
Cardiovascular disease
Hypertension
Hypotheses
Hypothesis testing
Internal Medicine
Mortality
Studies
Substance abuse treatment
Surgery
mitral valve
echocardiography
regurgitation
surgery
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Summary:After decades of study, the appropriate strategy for managing asymptomatic patients with severe mitral regurgitation (MR) remains controversial. Because no randomized, controlled trials (RCTs) have been performed, current "practice guidelines" are based on inferences drawn from comparison of observational cohorts. Generally perceived consistency among these studies has led to a relatively firm consensus that asymptomatic patients should undergo mitral valve surgery when they manifest any one of several "high risk descriptors," identified from the observational cohorts (1-3), unless symptoms develop first. [...]as more and more data have accumulated and the risks of surgery have progressively diminished, it has been suggested that severe MR, itself, should be an indication for surgery and that "watchful waiting" (i.e., close follow-up to detect the earliest occurrence of symptoms or high risk descriptors) should be abandoned (4).
ISSN:0735-1097
1558-3597
DOI:10.1016/j.jacc.2014.03.003