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. 2024 Jul 31;13(15):4487.
doi: 10.3390/jcm13154487.

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

Myrthe J M Welman  1   2   3 , Sebastian A F Streukens  1   2 , Anass Mephtah  3 , Loes P Hoebers  1   4 , Jindrich Vainer  1 , Ralph Theunissen  1 , Samuel Heuts  2   5 , Jos G Maessen  2   5 , Patrique Segers  5 , Kevin Vernooy  1   2 , Arnoud W J van 't Hof  1   2   4 , Peyman Sardari Nia  2   5 , Pieter A Vriesendorp  1   2
Affiliations

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

Myrthe J M Welman et al. J Clin Med. .

Abstract

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.

Keywords: Kaplan–Meier; conservative management mitral valve regurgitation; mitral valve disease; mitral valve management; mitral valve regurgitation; multidisciplinary decision-making; multidisciplinary mitral valve team.

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Conflict of interest statement

The authors declare no competing interests related to the study.

Figures

Figure 1
Figure 1
Flowchart decisions in mitral valve heart team.
Figure 2
Figure 2
Estimated survival outcomes of treatment decisions in (a) degenerative mitral valve disease; and (b) functional mitral valve disease. The red dotted line represents the general population.
Figure 3
Figure 3
Estimated survival: a comparative analysis of conservative treatment strategies. (a) Overall survival comparison for different conservative approaches; (b) surgical intervention versus patient’s autonomous choice for conservative treatment.
Figure 4
Figure 4
Estimated survival after propensity score matching: a comparative analysis of conservative treatment strategies versus surgery. (a) Estimated survival after propensity score matching: surgical versus non-severe degenerative mitral regurgitation; (b) estimated survival after propensity score matching: surgical versus non-severe functional mitral regurgitation; (c) estimated survival after propensity score matching: surgical versus medication-based treatment for degenerative mitral regurgitation; (d) estimated survival after propensity score matching: surgical versus medication-based treatment for functional mitral regurgitation.
See this image and copyright information in PMC

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