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- Title
Outcomes of Mitral Valve Regurgitation Management after Expert Multidisciplinary Valve Team Evaluation.
- Authors
Welman, Myrthe J. M.; Streukens, Sebastian A. F.; Mephtah, Anass; Hoebers, Loes P.; Vainer, Jindrich; Theunissen, Ralph; Heuts, Samuel; Maessen, Jos G.; Segers, Patrique; Vernooy, Kevin; van 't Hof, Arnoud W. J.; Sardari Nia, Peyman; Vriesendorp, Pieter A.
- Abstract
Background/Objectives: Mitral regurgitation (MR) affects millions worldwide, necessitating timely intervention. There are significant clinical challenges in the conservative management of MR, leaving a knowledge gap regarding the impact of multidisciplinary decision-making on treatment outcomes. This study aimed to provide insights into the impact of multidisciplinary decision-making on the survival outcomes of MR patients, focusing on conservative approaches. Methods: This study retrospectively analyzes 1365 patients evaluated by an expert multidisciplinary heart team (MDT) in a single center from 2015 to 2022. Treatments included surgery, catheter-based interventions, and conservative management. Propensity matching was utilized to compare surgery and conservative approaches. Results: Surgical intervention was associated with superior long-term survival outcomes compared to conservative and catheter-based treatments, particularly for degenerative MR (DMR). Survival rates of patients deemed by the MDT to have non-severe DMR were comparable to surgical patients (HR 1.07, 95% CI: 0.37–3.12, p = 0.90). However, non-severe functional MR (FMR) patients trended towards elevated mortality risk (HR 1.77, 95% CI: 0.94–3.31, p = 0.07). Pharmacological treatment for DMR was associated with significantly higher mortality compared to surgery (HR 8.0, 95% CI: 1.78–36.03, p = 0.001). Functional MR patients treated pharmacologically exhibited a non-significantly higher mortality risk compared to surgical intervention (HR 1.93, 95% CI: 0.77–4.77, p = 0.20). Conclusions: Survival analysis revealed significant benefits for surgical intervention, contrasting with elevated mortality risks associated with conservative management. "Watchful waiting" may be appropriate for non-severe DMR, while FMR may require closer monitoring. Further research is needed to assess the impact of regular follow-up or delayed surgery on survival rates, as pharmacological therapy has limited long-term efficacy for DMR.
- Subjects
MITRAL valve; SURVIVAL rate; WATCHFUL waiting; SURVIVAL analysis (Biometry); DRUG therapy; MITRAL valve insufficiency
- Publication
Journal of Clinical Medicine, 2024, Vol 13, Issue 15, p4487
- ISSN
2077-0383
- Publication type
Article
- DOI
10.3390/jcm13154487