Earlier surgical intervention for mitral valve disease is better for most patients

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 mitral valve is the most complex of the heart’s 4 valves and is the one most commonly associated with disease. There are 3 main conditions that affect the valve: Obstruction (stenosis), leakage (regurgitation), and bulging backward during valve closure (prolapse). Prolapse is the most common, occurring in up to 5% of the population, whereas stenosis is the least common, accounting for less than 1% of cardiac diagnoses in the United States, although it is more frequently seen in developing nations.

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.