| 강덕현, 김정훈, 남효정, 남기병, 송종민, 최기준, 송재관, 이재원¹, 박성욱, 박승정 |
The optimal timing of surgical intervention remains controversial in asymptomatic severe mitral regurgitation (MR) without dysfunction of left ventricle (LV), and we tried to compare long-term results of early surgery to conventional treatment strategy based on current guidelines.
Methods: From 1996 to 2005, we prospectively included a total of consecutive 409 patients (223 men, age;53±16 yrs) with severe degenerative MR, and the exclusion criteria were defined as the presence of exertional dyspnea, ejection fraction (EF)<0.60, LV end-systolic diameter (ESD) >40 mm, significant aortic valve disease and pulmonary hypertension. Severe degenerative MR was defined as severe prolapse or flail leaflet of mitral valve (MV) with the radius of proximal isovelocity surface area > 8 mm documented by echocardiography. Events were defined as the occurrences of cardiac death and MV surgery during follow-up.
Results: Early surgery was performed on 138 patients (group A), and conventional strategy was chosen on 271 patients (group B). In group A, MV repair and replacement was successfully performed in 117 (85%) cases and in 21 (15%) cases, respectively. There were no significant differences between the two groups in terms of age (group A vs group B; 53±14 yrs vs 53±16 yrs), gender (% of male; 50% vs 57%), EF (67±4% vs 66±4%), and ESD (34±4 mm vs 34±4 mm), but the incidences of atrial fibrillation (18% vs 8%) and flail leaflet (51% vs 28%) were significantly higher in group A (p<0.01). During follow-up of 55±30 months, there were no cardiac death, 1 case of MV reoperation in group A, and 8 cardiac deaths, 39 cases of late MV surgery in group B. The cardiac death rate was significantly lower in group A than group B (p<0.05), and the event-free survival rate was 94±2% at 2 yrs, 86±2% at 4 yrs, and 72±4% at 6 yrs in group B. Conclusions: The conventional treatment strategy showed satisfactory long-term results, but early surgery can be recommended for asymptomatic severe degenerative MR in selected centers with excellent results of MV repair.
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