Outcome of Watchful Waiting in Asymptomatic Severe Mitral Regurgitation

Rosenhek, Raphaël; Rader, Florian; Klaar, Ursula; Gabriel, Harald; Krejc, Marcel; Kalbeck, Daniel; Schemper, M.; Maurer, Gerald; Baumgartner, Helmut

doi:10.1161/circulationaha.105.599175

Cited by 440 publications

(289 citation statements)

References 44 publications

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“…49,50 Two recent series involved patients with mitral regurgitation who were initially asymptomatic and had a normal left ventricular function. 51,52 Enriquez-Sarano et al examined prospectively 456 patients with asymptomatic organic mitral regurgitation and showed that the 5-year mortality from any cause was 22% and the cardiac mortality was 14% in patients managed medically. Cardiac surgery was ultimately performed in 232 patients and was associated with improved survival.…”

Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

“…A total of 38 patients developed indications for surgery and those with a flail leaflet tended to develop criteria for surgery slightly, but not significantly earlier. 52 Despite the lack of randomized trials, all the prospective, observational data showed that in asymptomatic patients with initially preserved ejection fraction, severe mitral regurgitation has a high likelihood of requiring surgery over the next 6-10 years, because of heart failure symptoms or left ventricular dysfunction. 53,54 Many predictors of different clinical outcomes and especially mortality have been identified in patients with primary mitral regurgitation.…”

Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

“…52 The group examined 132 asymptomatic patients with severe degenerative mitral regurgitation due to flail leaflets or valve prolapse. The patients had close clinical and echocardiographic follow-up, at least every 12 months and in some case every 3-6 months and were referred for surgery when a Class I or a IIa trigger was reached.…”

Section: Mitral Valve Repair Versus Replacementmentioning

confidence: 99%

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Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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Mitral regurgitation is the second most common valvular disorder requiring surgical intervention worldwide. This review summarizes the current understanding of primary, degenerative mitral regurgitation with respect to etiology, comprehensive assessment, natural history and management. The new concept of staging of the valvular disorders, newer predictors of adverse and controversy of ‘‘watchful waiting’’ versus ‘‘early surgical intervention’’ for severe, asymptomatic, primary mitral regurgitation are addressed.

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Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

Section: Natural History Progression and Predictors Of Outcomes In Mmentioning

confidence: 99%

Section: Mitral Valve Repair Versus Replacementmentioning

confidence: 99%

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Primary mitral valve regurgitation: Update and review

Apostolidou

Maslow

Poppas

2017

gcsp

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“…When severe MR is present, approximately 5% to 10% of patients per year develop (a) significant symptoms (LV failure, pulmonary hypertension, atrial fibrillation, and stroke); (b) clinical indications for surgery; (c) death; or all of these. 8,9 The optimal timing for corrective intervention in chronic mitral regurgitation is widely debated ( Table 1). For degenerative MR in asymptomatic individuals, this depends upon a balance between the risk of early surgery and rates of successful repair, with the potential risk of irreversible left ventricular dysfunction if the intervention is performed too late after either the development of symptoms or the fall in left ventricular ejection fraction.…”

Section: Timing Of Interventionmentioning

confidence: 99%

Percutaneous Treatment of Mitral Regurgitation: Present and Future

Athappan

Sorajja

Gössl

2017

Journal of the Minneapolis Heart Institute Foundation

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Mitral valve regurgitation poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe mitral valve regurgitation. Surgical correction with mitral valve repair or replacement is the mainstay of therapy. However, a significant proportion of elderly patients are not eligible for mitral valve repair or replacement due to prohibitive surgical risk from increased age, poor ventricular function, or associated comorbidities. Percutaneous mitral valve repair/ replacement techniques have been developed to fill this void. The most advanced percutaneous technique with the highest safety and efficacy to date is the edge-to-edge MitraClip repair system. The majority of other catheter-based mitral valve repair/ replacement devices are at early developmental stages, but have shown encouraging initial results in feasibility trials. Transcatheter mitral valve replacement holds promise to emerge as the leading transcatheter treatment of choice in the future. KEY WORDS degenerative MR, functional MR, MitraClip, TMVR n INTRODUCTIONMitral valve regurgitation (MR) poses a significant public health burden, with more than 3 million people in the US alone suffering from moderate or severe MR.1 Left untreated, chronic MR results in heart failure symptoms, left ventricular cavity dilation and systolic dysfunction, left atrial enlargement, atrial fibrillation (AF), and pulmonary hypertension. In patients with severe primary/degenerative MR, an early repair of the structural defect is crucial to avoid irreversible sequela.2 In patients with secondary/functional MR, optimal medical therapy is a key component in the treatment of the underlying cardiomyopathy and may provide relief from symptoms. However, unless the cardiomyopathy and secondary/functional MR improves significantly under therapy, surgical or interventional options need to be considered. 3 Surgical correction with mitral valve repair (MVRe) or replacement (MVR) remain the mainstay of therapy for primary and secondary MR. Even so, because of the invasive nature of open-heart surgery (OHS) and the frequent presence of comorbidities in this group, up to 50% of patients with severe MR may not be offered surgery.4 This is especially true for older patients with multiple comorbidities and those with impaired left ventricular function. As a result, percutaneous technology is poised to significantly alter the treatment paradigm for chronic MR. Percutaneous MVRe or MVR offers the potential benefit of decreased morbidity, improved recovery time, and shorter hospital stays compared with OHS. In this review we summarize the devices that have been developed for percutaneous transcatheter mitral valve repair or replacement and their preliminary clinical results. Anatomy of the Mitral Valve ComplexAn appreciation of the complex anatomy of the mitral valve is of importance to understand the challenges in development of percutaneous MVRe or MVR technologies and for selection of the most optimal repair/replacement technique.T...

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“…In the western world, major cause of MR is degenerative while in the developing countries, rheumatic heart disease continues to be an important aetiology along with mitral valve degeneration in older subjects. No large-scale data on the natural history of asymptomatic rheumatic MR are available, although such data are reported on degenerative MR. [2][3][4] We do not know if what is true for degenerative MR applies to rheumatic MR as well. Degenerative MR is progressive while rheumatic MR severity may remain static for a long period due to relatively fixed valve.…”

mentioning

confidence: 99%