Dr. Sarano says the quantitative data from this study, combined with advances in surgical techniques and improved surgical results, help define at what severity of regurgitation patients should strongly consider valve surgery.
"The mortality for valve surgery is very low, but it is not zero," Dr. Sarano explains. "Previously, with patients who were asymptomatic, we had no well-defined quantitative method to determine when the risk of continuing to rely on medication alone exceeded the risk of surgery. Now we have a threshold established through this large study, where continuing medical management carries a much higher risk and surgery can restore normal life expectancy."
Dr. Sarano says the study has important implications for patients and the physicians who treat them. "We examined dozens of variables in this study, and the one physical measurement that strongly predicted survival was regurgitant orifice," he explains. "Patients should be aware that severe mitral regurgitation increases their risk of dying even if they don't have symptoms, and that now we have a measurement technique to determine how severe is too severe and who benefits the most from early intervention."
Other authors of the paper include Jean-Francois Avierinos, M.D.; David Missika-Zeithoun, M.D.; Delphine Detain, M.D.; Maryann Capps; Vuyisile Nkomo, M.D.; Christopher Scott; Hartzell Schaff, M.D. and A. Jamil Tajik, M.D., all of Mayo Clinic.