Association Between Early Surgical Intervention vs Watchful Waiting and Outcomes for Mitral Regurgitation Due to Flail Mitral Valve Leaflets

Abstract

Degenerative mitral regurgitation is common and can be surgically repaired in the vast majority of patients,^1,2 improving symptoms and restoring normal life expectancy.^3-6 Despite the safety and efficacy of contemporary surgical correction, an ongoing international debate persists regarding the need for early intervention^7-9 in patients without the American College of Cardiology (ACC)/American Heart Association (AHA) guideline class I triggers (no or minimal symptoms and absence of left ventricular dysfunction). This is in part propagated by discordant views of the prognostic consequences of uncorrected severe mitral regurgitation; considered as benign by those supporting medical watchful waiting¹⁰ (nonsurgical observation until a distinct event is encountered) vs conveying excess mortality and morbidity (including heart failure and atrial fibrillation) by those advocating early surgical intervention.^5,11 This controversy is reflected in current international consensus statements, in which North American documents categorize early mitral surgery as a class IIA recommendation (in favor of the procedure),¹² whereas it is a class IIB recommendation in Europe (not strongly in favor of the procedure).¹³