What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery?
Mariana Mirabel,Bernard Iung,Gabriel Baron,David Messika-Zeitoun,Delphine Detaint,Jean-Louis Vanoverschelde,Butchart Eg,Philippe Ravaud,Alec Vahanian +8 more
TLDR
Impaired LVEF, older age, and comorbidity were the most striking characteristics of patients who were denied surgery in patients with severe symptomatic mitral regurgitation who are denied surgery.Abstract:
Aim To identify the proportion and characteristics of patients with severe symptomatic mitral regurgita tion (MR) who are denied surgery. Methods and results In the Euro Heart Survey on valvular heart disease, 396 patients had severe symptomatic MR as assessed by Doppler-echocardiography (grade >= 3/4) and New York Heart Association class 11 or greater. Patient characteristics were analysed according to the decision to operate or not. A decision not to operate was taken in 193 patients (49%). In multivariable analysis, decreased left ventricular ejection fraction (LVEF) [OR= 1.39 per 10% decrease, 95% CI (1.17-1.66), P = 0.0002], non-ischaemic aetiology [OR = 4.44, 95% CI (1.96-10.76), P = 0.0006], older age [OR = 1.40 per 10-year increase, 95% CI(1.15-1.72), P=0.001], increased Charlson comorbidity index [OR= 1.38 per 1 point increase, 95% CI (1.12-1.72), P = 0.004], and grade 3 MR [OR = 2.23, 95% CI (1.28-3.29), P = 0.005] were associated with the decision not to operate. One-year survival was 96.0 +/- 1.4% in patients with a positive decision for intervention vs. 89.5 +/- 2.3% in those with a negative decision (P = 0.02). Conclusion Surgery was denied in 49% of patients with severe symptomatic MR. Impaired LVEF, older age, and comorbidity were the most striking characteristics of patients who were denied surgery. The weight of age and LVEF in the decision do not seem justified according to current knowledge.read more
Citations
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Guidelines on the management of valvular heart disease The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology
Alec Vahanian,Helmut Baumgartner,Jeroen J. Bax,Butchart Eg,Robert Dion,Gerasimos Filippatos,Frank A. Flachskampf,Roger Hall,Bernard Iung,Jarosław D. Kasprzak,Patrick Nataf,Pilar Tornos,Lucia Torracca,Arnold Wenink,Silvia G. Priori,Jean-Jacques Blanc,Andrzej Budaj,John Camm,Veronica Dean,Jaap W. Deckers,Kenneth Dickstein,John Lekakis,Keith McGregor,Marco Metra,João Morais,Ady Osterspey,Juan Tamargo,José Luis Zamorano,Annalisa Angelini,Manuel J. Antunes,Miguel Ángel García Fernández,Christa Gohlke-Baerwolf,Gilbert Habib,John J.V. McMurray,Catherine M Otto,Luc Pierard,José L. Pomar,Bernard Prendergast,Raphael Rosenhek,Miguel Sousa Uva +39 more
TL;DR: Guidelines and Expert Consensus Documents aim to present management recommendations based on all of the relevant evidence on a particular subject in order to help physicians select the best possible management strategies for the individual patient suffering from a specific condition, taking into account the impact on outcome and also the risk–benefit ratio of a particular diagnostic or therapeutic procedure.
Journal ArticleDOI
Guidelines on the management of valvular heart disease (version 2012)
Alec Vahanian,Ottavio Alfieri,Felicita Andreotti,Manuel J. Antunes,Gonzalo Barón-Esquivias,Helmut Baumgartner,Michael A. Borger,Thierry Carrel,Michele De Bonis,Arturo Evangelista,Volkmar Falk,Bernard Iung,Patrizio Lancellotti,Luc Pierard,Susanna Price,Hans-Joachim Schäfers,Gerhard Schuler,Janina Stępińska,Karl Swedberg,Johanna J.M. Takkenberg,Ulrich O. von Oppell,Stephan Windecker,José Luis Zamorano,Marian Zembala +23 more
TL;DR: Guidelines summarize and evaluate all evidence available on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient with a given condition, taking into account the impact on outcome.
Journal ArticleDOI
Guidelines on the management of valvular heart disease (version 2012)The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)
Journal ArticleDOI
Acute and 12-Month Results With Catheter-Based Mitral Valve Leaflet Repair: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study
Patrick L. Whitlow,Ted Feldman,Wes R. Pedersen,D. Scott Lim,Robert Kipperman,Richard W. Smalling,Tanvir Bajwa,Howard C. Herrmann,John M. Lasala,James T. Maddux,Murat Tuzcu,Samir R. Kapadia,Alfredo Trento,Robert J. Siegel,Elyse Foster,Donald D. Glower,Laura Mauri,Saibal Kar,Everest Investigators +18 more
TL;DR: The EVEREST II (Endovascular Valve Edge-to-Edge Repair) High Risk Study (HRS) assessed the safety and effectiveness of the MitraClip device (Abbott Vascular, Santa Clara, California) in patients with significant mitral regurgitation (MR) at high risk of surgical mortality rate.
Journal ArticleDOI
EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease
José Luis Zamorano,Luigi P. Badano,Charles J. Bruce,Kwan-Leung Chan,Alexandra Gonçalves,Rebecca T. Hahn,Martin G. Keane,Giovanni La Canna,Mark J. Monaghan,Petros Nihoyannopoulos,Frank E. Silvestry,Jean-Louis Vanoverschelde,Linda D. Gillam +12 more
TL;DR: This document is intended that this document will serve as a reference for echocardiographers participating in any or all stages of new transcatheter treatments for patients with valvular heart disease.
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