Mon 10 April 2017
Chronic mitral valve regurgitation (leaky mitral valve) is associated with the development of atrial fibrillation (irregular heart beat) and pulmonary hypertension (high blood pressure in the lungs) which can occur even in the absence of symptoms. It is widely accepted that these consequences can be avoided with early surgery, which can also improve the long term response to mitral valve intervention. In other words, whilst surgery is important whether or not you have developed atrial fibrillation or pulmonary hypertension, early intervention before these complications develop is much better.
This was clearly demonstrated in a recent study (2015) of 382 patients, which showed significantly reduced long term survival in those patients who had established atrial fibrillation/pulmonary hypertension at the time of undergoing mitral valve surgery. In addition, the incidence of major cardiac and cerebrovascular events, recurrent mitral valve regurgitation, and need for reoperation was significantly higher in the atrial fibrillation/pulmonary hypertension group.
This data supports the recent guidelines published by the AHA/ACC (2014) which stress the importance of early surgery in asymptomatic patients with severe mitral valve regurgitation if the probability of repair is higher than 95% with low mortality (<1%).
Eur J Cardiothorac Surg (2015) doi: 10.1093/ejcts/ezu511First published online: January 5, 2015 http://ejcts.oxfordjournals.org/content/early/2015/01/05/ejcts.ezu511.abstract#fn-1