Surgery associated with significantly lower rate of heart failure hospitalization, all-cause mortality despite more severe disease status
By Elana Gotkine HealthDay Reporter
THURSDAY, Aug. 22, 2024 (HealthDay News) — For patients with atrial functional mitral regurgitation (AFMR), mitral valve (MV) surgery is associated with lower rates of adverse clinical outcomes, according to a study published online Aug. 15 in JAMA Network Open.
Nobuyuki Kagiyama, M.D., Ph.D., from Juntendo University Graduate School of Medicine in Tokyo, and colleagues examined the prevalence, clinical characteristics, and outcomes of MV surgery in AFMR in a retrospective cohort study conducted across 26 Japanese centers.
Overall, 8,867 of the 177,235 patients who underwent echocardiography had moderate or severe MR. Within this group, 11.4 percent were diagnosed with AFMR (80.1 percent had atrial fibrillation). One hundred thirteen of these patients underwent MV surgery, and 81.4 percent received concurrent tricuspid valve surgery. The researchers found that compared with patients who remained under medical therapy, those who underwent surgery were younger, but they had more severe MR (57.5 versus 9.4 percent), a larger mean left atrial volume index (152.5 versus 87.7 mL/m2), and a higher prevalence of heart failure (New York Heart Association class III or IV: 26.5 versus 9.3 percent). Overall, 28.4 percent of patients experienced the primary outcome of heart failure hospitalization and all-cause mortality during a median follow-up of 1,050 days. Only the surgical group had a decrease in natriuretic peptide levels at follow-up and a significantly lower rate of the primary outcome (three-year event rates, 18.3 versus 33.3 percent) despite a more severe disease status.
“Future clinical trials are warranted to investigate the causal relationship between MV surgery and clinical outcomes in patients with severe AFMR,” the authors write.
Several authors disclosed ties to the biopharmaceutical and medical device industries.
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