Chirurgie der degenerativen Mitralinsuffizienz auch beim asymptomatischen Patienten?

Summary It is well known that the natural course of moderate to severe mitral regurgitation in asymptomatic patients is not entirely benign. The purpose of this study was to investigate whether an operation at an early stage before worsening of functional class and left ventric- ular function or atrial fibrillation occur might improve long term prognosis. From 1987 to 2006 a consecutive series of 688 patients underwent surgery for degenera- tive mitral regurgitation and was followed retrospectively for risk factors like age, type of operation (reconstruction vs replacement), thrombo-embolism and bleeding episodes, re- operation for residual or recurrent regurgita- tion, NYHA class, left ventricular function and cardiac rhythm. Long-term survival was better and compli- cations were fewer if the valve could be re- paired rather than replaced. A preoperative lower functional class, better left ventricular function and sinus rhythm were significantly associated with improved survival and lower rates of atrial fibrillation late postoperatively. The analysis, however, is complicated by a slightly older age of patients with these risk factors. Conclusion: Surgery for degenerative, moder- ate to severe mitral regurgitation should be recommended before symptoms arise, cardiac function deteriorates or atrial fibrillation oc- curs, particularly if the valve can be repaired.