HEART VALVE SURGERY STUDY

Would you get heart valve surgery if you didn’t have any symptoms?
New research says many patients with a common heart valve problem should have performed a heart valve surgery.
The study looks at a problem with the mitral valve, which is the heart valve that separates the upper and lower chambers on the left side of the heart. A condition called mitral valve regurgitation sometimes affects this valve, requiring heart valve surgery.

“I went in to the hospital with shortness of breath, pressure on my left arm and on my sides. They said right away you need heart valve surgery.” Masood Mughel had coronary artery disease, and probably as a result he had problems with one of his heart valves- his mitral valve.
“The heart size increases and as it increases it stretches some of the elements of the heart,” says Dr. Robert Lowery, chief of cardiothoracic surgery at SUNY Downstate Medical Center.
“They said the valve is not functioning well,” states Masood. And it was causing him to go into heart failure. His life would be in danger unless he had heart valve surgery immediately.
When patients like Masood start having symptoms from a bad mitral valve, causing the problem called mitral valve regurgitation, the treatment plan is a no-brainer- they need heart valve surgery.
“Blood is supposed to flow down from the left upper chamber to the left lower chamber,” states Dr. Jason Lazar, Director of Non-Invasive Cardiology at SUNY Downstate Medical Center. “But it’s not supposed to go backwards, which happens with mitral valve regurgitation.”
There are around five to six million Americans with the problem mitral valve regurgitation many of whom have no symptoms. It’s usually detected on a routine exam like an echocardiogram, and doctors typically treat the problem with medicine.
But now, important new research in the New England Journal of Medicine shows in many of these patients, heart valve surgery should be done before they get to the point of having symptoms.
Dr. Lowery says, “For the first time, it shows that patients who are asymptomatic may improve with heart valve surgery to bring their mortality risk back down to that of the normal population.”
Patients without symptoms but with the most severe form of mitral valve regurgitation, with the largest opening, had five times the risk of death compared to those with the mildest form of mitral valve regurgitation. The implication would be that perhaps these patients should be followed on a regular basis, get echocardiograms to see if the condition is worsening. And if the opening and regurgitation gets big enough, even without symptoms, the best course now is to perform heart valve surgery.
“The worse the mitral regurgitation the better the patients did,” says Dr. Lowery.
Masood’s operation to repair his mitral valve was successful. His life expectancy is now much longer given he had his surgery. “I feel as if I am born again,” says Masood.
According to the researchers, the heart valve surgery markedly reduces the risk of heart failure and death, and overall, normalizes the patient’s life expectancy, especially in those with the most dramatic cases of mitral regurgitation. So it has a dramatic result in patients who, while they have no symptoms, are at a high risk of dying from mitral valve regurgitation.