ECHO 2013 / Asymptomatic Valvular Disease When to Intervene
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MR Due to Flail Leaflet Long-Term Survival with Medical Therapy
Survival (%)
100 |
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80 |
Expected |
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65% |
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60
Observed
57%
40
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annual mortality = 6.3%/yr |
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p = 0.016 |
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20 |
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0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
Years after Diagnosis
Ling (Mayo Clinic) NEJM 335:1417(1996)
The more severe the regurgitation the poorer the prognosis
100 |
ERO < 20 mm2 |
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(%) |
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ERO 20-39 mm2 |
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Survival |
ERO > 40 mm2 |
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50 |
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Years |
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1 |
3 |
5 |
Enriquez-Sarano, M. et al. N Engl J Med 2005;352:875-883
Recommendations for MV Operation in Chronic Severe MR
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Indication |
Class |
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3. MV surgery is beneficial for asymptomatic patients |
I |
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with chronic, severe MR and mild to moderate LV |
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dysfunction, EF 30-60% and/or end-systolic |
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dimension > 40mm |
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(Level of evidence: B) |
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I IIa IIb III
B
Bonow ACC/AHA Practice Guidelines JACC 48:e1(2006)
Recommendations for MV Operation in Chronic Severe MR
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Indication |
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Class |
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5. MV repair is reasonable in experienced surgical |
IIa |
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centers for asymptomatic pts with chronic severe |
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MR with preserved LV function (ejection fraction |
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greater than 0.60 and end-systolic dimension less |
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than 40 mm) in whom the liklihood of successful |
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repair without residual MR is greater than 90%. |
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(Level of evidence: B) |
I |
IIa IIb III |
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B |
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6. MV surgery is reasonable for asymptomatic pts with |
IIa |
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chronic severe MR with preserved LV function, and |
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new onset atrial fibrillation. |
I |
IIa IIb III |
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(Level of evidence: C) |
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C |
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Bonow ACC/AHA Practice Guidelines JACC 48:e1(2006)
Recommendations for MV Operation in Chronic Severe MR
|
Indication |
Class |
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5. MV repair is reasonable in experienced surgical |
IIa |
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centers for asymptomatic pts with chronic severe |
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MR with preserved LV function (ejection fraction greater than 0.60 and end-systolic dimension less than 40 mm) in whom the liklihood of successful repair without residual MR is greater than 90%.
(Level of evidence: B) |
I IIa IIb III |
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B |
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6. MV surgery is reasonable for asymptomatic pts with IIa chronic severe MR with preserved LV function, and
new onset atrial fibrillation. |
I IIa IIb III |
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(Level of evidence: C) |
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C |
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Bonow ACC/AHA Practice Guidelines JACC 48:e1(2006)
Recommendations for MV Operation in Chronic Severe MR
Indication |
Class |
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7. MV surgery is reasonable for asymptomatic pts with |
IIa |
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chronic severe MR, preserved LV function, and |
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pulmonary hypertension (PA systolic systolic |
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pressure greater than 50 mm Hg at rest or greater |
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than 50 mm Hg at rest or greater than 60 mm Hg |
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with exercise). |
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(Level of evidence: C) |
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I IIa IIb III |
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C |
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Bonow ACC/AHA Practice Guidelines JACC 48:e1(2006)\
ACC/AHA Guidelines for Valvular Heart Disease
Mitral Regurgitation: Indications operation
1.Any symptoms
2.LV dysfunction
3.Asymptomatic If repairable
If low risk for OR
If truly severe
Asymptomatic
AR