Outcomes of Mitral Valve Regurgitation Management after Expert Multidisciplinary Valve Team Evaluation

被引:0
作者
Welman, Myrthe J. M. [1 ,2 ,3 ]
Streukens, Sebastian A. F. [1 ,2 ]
Mephtah, Anass [3 ]
Hoebers, Loes P. [1 ,4 ]
Vainer, Jindrich [1 ]
Theunissen, Ralph [1 ]
Heuts, Samuel [2 ,5 ]
Maessen, Jos G. [2 ,5 ]
Segers, Patrique [5 ]
Vernooy, Kevin [1 ,2 ]
van't Hof, Arnoud W. J. [1 ,2 ,4 ]
Nia, Peyman Sardari [2 ,5 ]
Vriesendorp, Pieter A. [1 ,2 ]
机构
[1] Maastricht Univ, Med Ctr, Dept Cardiol, P Debyelaan 25, NL-6229 HX Maastricht, Netherlands
[2] Maastricht Univ, Cardiovasc Res Inst Maastricht CARIM, Univ Singel 50, NL-6229 ER Maastricht, Netherlands
[3] Maastricht Univ, Fac Hlth Med & Life Sci, Univ Singel 60, NL-6229 ER Maastricht, Netherlands
[4] Zuyderland Med Ctr, Dept Neurol, Henri Dunantstr 5, NL-6419 PC Heerlen, Netherlands
[5] Maastricht Univ, Dept Cardiothorac Surg, Med Ctr, P Debyelaan 25, NL-6229 HX Maastricht, Netherlands
关键词
multidisciplinary mitral valve team; multidisciplinary decision-making; mitral valve disease; mitral valve regurgitation; mitral valve management; Kaplan-Meier; conservative management mitral valve regurgitation; EUROPEAN ASSOCIATION; SURGERY; REPAIR; RECOMMENDATIONS; SURVIVAL;
D O I
10.3390/jcm13154487
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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.
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页数:13
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