A more aggressive approach to treating degenerative mitral valve disease, using earlier surgical intervention and less invasive techniques, is more beneficial to the patient than “watchful waiting,” according to an article in the June 2015 issue of The Annals of Thoracic Surgery.
Degenerative mitral valve disease is irreversible. It eventually leads to regurgitation (blood leaking backwards through the valve) and heart failure. While surgical treatment of the disease has evolved, there is still debate about the value of watchful waiting versus early surgical repair for patients without symptoms.
Farhang Yazdchi, MD, MS, and colleagues, from the Cleveland Clinic in Ohio, assessed trends in patient characteristics, timing of intervention, and surgical techniques for mitral valve regurgitation by reviewing the records of 5,902 patients over a 25-year period (January 1, 1985 to January 1, 2011).
They found that improved technology and earlier intervention have led to more patients benefitting from less invasive surgical repair before suffering from disease symptoms, such as atrial fibrillation (irregular, often rapid heart rate) or heart failure.
“Surgery is almost unavoidable in patients with severe degenerative mitral valve regurgitation. Our study has shown that the key to successful treatment is a timely referral for surgical intervention at an advanced repair center with highly skilled heart teams,” said Dr. Yazdchi.
The researchers found that patients who were treated in the latter years of the study (2005-2011) were released from the hospital about 2 days sooner than those treated in the earliest years of the study (1985-1997). Two main reasons for the shortened stay were fewer full sternotomies (large chest incisions)—25% in the latter years vs. 93% in the earliest years- and more patients were asymptomatic - 44% in the latter years vs. 25% in the earliest years.
In mitral valve disease, the mitral valve, which is located between your left heart chambers (left atrium and left ventricle), doesn’t work properly.
Types of mitral valve disease include:
Mitral valve regurgitation. In this condition, the flaps (leaflets) of the mitral valve don’t close tightly, causing blood to leak backward into the left atrium of your heart. If not treated, it can result in heart muscle damage.
The most common cause of blood leakage is mitral valve prolapse, in which the leaflets bulge back into the left atrium as your heart contracts.
Mitral valve stenosis. In this condition, the flaps of the mitral valve become thick or stiff, and they may fuse together. This results in a narrowed valve opening and reduced blood flow from the left atrium to the left ventricle.
“Successful mitral valve repair at the Cleveland Clinic has reached a level of almost 100%, while mortality rates have remained extremely low and hospital length of stay shortened,” said Dr. Yazdchi. “Patients who are diagnosed with severe mitral valve regurgitation should seek surgical consultation sooner rather than later, even if they are not having any symptoms.
Notes for editors
Earlier surgical intervention using less invasive surgical techniques is better than watchful waiting for patients with degenerative mitral valve disease.
Over the 25 years observed, mortality rates remained low, hospital length of stay was shorter, and surgical repair became less invasive in the latter years of the study.
Researchers said the key to successful treatment is a timely referral for surgical intervention at an advanced repair center with highly skilled heart teams.
Increasing Disadvantage of “Watchful Waiting” for Repairing Degenerative Mitral Valve Disease
doi:10.1016/j.athoracsur.2015.01.065 The Annals of Thoracic Surgery published by Elsevier. http://www.sciencedirect.com/science/article/pii/S0003497515002167
About The Annals of Thoracic Surgery
The Annals of Thoracic Surgery is the official journal of STS and the Southern Thoracic Surgical Association. Founded in 1964, The Society of Thoracic Surgeons is a not-for-profit organization representing more than 6,800 cardiothoracic surgeons, researchers, and allied health care professionals worldwide who are dedicated to ensuring the best possible outcomes for surgeries of the heart, lung, and esophagus, as well as other surgical procedures within the chest. The Society’s mission is to enhance the ability of cardiothoracic surgeons to provide the highest quality patient care through education, research, and advocacy.
Elsevier is a world-leading provider of information solutions that enhance the performance of science, health, and technology professionals, empowering them to make better decisions, deliver better care, and sometimes make groundbreaking discoveries that advance the boundaries of knowledge and human progress. Elsevier provides web-based, digital solutions - among them ScienceDirect, Scopus, Elsevier Research Intelligence and ClinicalKey - and publishes over 2,500 journals, including The Lancet and Cell, and more than 33,000 book titles, including a number of iconic reference works. Elsevier is part of RELX Group plc, a world-leading provider of information solutions for professional customers across industries.