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Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly

Title
Initial surgery versus conservative management of symptomatic severe mitral regurgitation in the elderly
Author
허란
Keywords
mitral regurgitation; valve disease surgery
Issue Date
2017-10
Publisher
BMJ PUBLISHING GROUP
Citation
HEART, v. 104, no. 10, page. 849-854
Abstract
Objective In elderly patients, the benefit of surgical correction of severe mitral regurgitation (MR) may not be greater than the operative risk. This study sought to compare the long-term clinical outcomes between initial surgery and conservative management in elderly patients (>= 70 years of age) with severe MR.Methods We prospectively evaluated 157 consecutive patients (75 men, 74 +/- 4 years of age) with severe degenerative MR and mild symptoms. Mitral valve surgery was performed on 79 (initial surgery group), whereas the conservative strategy was chosen for 78 patients (conservative management group). We compared the overall and cardiac mortality and cardiac event between strategies in the overall and propensity-matched cohort (46 pairs).Results During the median follow-up of 5.4 years, overall death occurred less in the initial surgery group (16 vs 37 patients). This group showed reduced cardiac mortality (HR 0.31; 95% CI 0.13 to 0.73; p=0.007), overall mortality (HR 0.39; 95% CI 0.21 to 0.74; p=0.004) and cardiac event (HR 0.26; 95% CI 0.13 to 0.53; p<0.001). A significant reduction in cardiac mortality (HR 0.18; 95% CI 0.05 to 0.63; p=0.007), overall mortality (HR 0.36; 95% CI 0.15 to 0.86; p=0.022) and cardiac event (HR 0.20; 95% CI 0.07 to 0.52; p=0.001) in the initial surgery group was also observed in the propensity-matched cohort.Conclusions In elderly patients with severe degenerative MR and mild symptoms, initial surgical strategy was associated with significant long-term reductions in cardiac and overall mortality compared with conservative management.
URI
https://heart.bmj.com/content/104/10/849https://repository.hanyang.ac.kr/handle/20.500.11754/115910
ISSN
1355-6037; 1468-201X
DOI
10.1136/heartjnl-2017-311759
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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