New Data: Statins Benefit Those With CAD, Not Those Without
Statin efficacy to decrease MACE depends on CAD phenotypes and increases with the extent and severity of disease and in the presence of high-risk plaques.
When Do You Operate on Severe Mitral Regurgitation?
Disease of the 4 cardiac valves is not as common as coronary artery disease, but it is an issue we deal with at the KAHN CENTER. A number of patients can now be treated with catheter based (non-surgical) approaches, but many patients still require surgical repair or replacement of a heart valve.
The timing of surgery in asymptomatic severe mitral regurgitation (MR) remains controversial. Surgery too early exposes patients to all the risks and uncertain gain and surgery too late may expose patients to post-op heart damage to deal with.
A new and large observational study sought to compare long-term outcomes of early surgery with a conventional treatment strategy in asymptomatic patients with severe mitral regurgitation.
METHODS
From 1996 to 2016, a total of 1,063 consecutive asymptomatic patients (673 men; mean 51 years old) with severe degenerative MR and preserved left ventricular function were enrolled, and followed prospectively for a median of 12 years. Early surgery was performed on 545 patients and the conventional treatment strategy (medications) was chosen for 518 patients.
RESULTS
In the early surgery group, no operative deaths occurred, and mitral valve repair was successfully performed in 97% of patients. During follow-up, 8 (1.5%) patients in the early surgery group and 54 (10.4%) in the conventional management group died from cardiovascular causes.
A total of 74 (14%) deaths from any cause occurred in the early surgery group, whereas 116 (22%) occurred in the conventional management group.
The early surgery group had a significantly lower risk of cardiac mortality than the conventional treatment group and significantly lower cardiac mortality rates.
Compared with the conventional treatment group, the early surgery group also had a significantly lower risk of overall mortality and significantly lower overall mortality rates.
CONCLUSION
In this new study, compared with conventional management, early surgery is associated with better long-term outcomes among asymptomatic patients with severe MR and preserved left ventricular function.
This study provides a new and important piece of data for managing patients with MR at the KAHN CENTER. We are looking forward to more and more patients being treated with non-surgical, catheter based approaches like the MitraClip and PASCAL devices.
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