Mitral Surgery Timing Being Examined

[tobagotwo]

A step toward knowing "when"...

A clipping from an article on www.medpagetoday.com New Predictor for Mitral Regurgitation Outcomes By Jeff Minerd, MedPage Today Staff Writer
http://www.medpagetoday.com/tbindex1.cfm?tbid=641&thePhoto=Today's&CatName=Cardiology&CID=

The article references these three articles: http://abcnews.go.com/Health/wireStory?id=547629
and http://www.msnbc.msn.com/id/7067696/ and http://online.wsj.com/article/0,,SB110979011513868458,00.html?mod=health_hs_research%

"The data strengthen the concept that asymptomatic mitral regurgitation is a serious disease, with a 5-year rate of death from any cause of 22% and a 33% incidence of adverse cardiovascular events, including death from cardiac causes, heart failure, and new atrial fibrillation.

"An analysis of the association between clinical outcomes, regurgitant volume, and regurgitant orifice size yielded the following key results:

"Patients with an effective regurgitant orifice of at least 40 mm² had a five-year survival rate that was lower than expected on the basis of U.S. Census data (about 58% vs. 78%, P=0.03).

"As compared with patients with a regurgitant orifice of less than 20 mm2, those with an orifice of at least 40 mm² had an increased risk of death from any cause (adjusted risk ratio, 2.90), death from cardiac causes (adjusted risk ratio, 5.21), and cardiac events (adjusted risk ratio, 5.66). (For all, P<0.01.)

"Cardiac surgery performed on the 232 patients and was independently associated with improved survival (adjusted risk ratio, 0.28; P<0.01).

"Quantitative grading of mitral regurgitation is a powerful predictor of the clinical outcome of asymptomatic mitral regurgitation," the researchers concluded. "Patients with an effective regurgitant orifice of at least 40 mm² should promptly be considered for cardiac surgery."

"Several caveats were pointed out in an accompanying editorial by Drs Catherine M. Otto, and Christopher T. Salerno, however. "First, these data. apply only to patients with isolated primary mitral regurgitation; in patients with mixed-valve lesions, secondary mitral regurgitation, or left ventricular dysfunction, the situation is more complex," they wrote. "Second, quantitative evaluation of the severity of mitral regurgitation is time-consuming and technically demanding; accurate results depend on a meticulous approach by an experienced laboratory.""