TY - JOUR
T1 - Identification of the Asymptomatic Patient with Severe Mitral Regurgitation
T2 - Discrepancy Between Research and Clinical Practice
AU - Jansen, Rosemarijn
AU - Kluin, Jolanda
AU - Ray, Simon G.
AU - Cramer, Maarten Jan M
AU - Suyker, Willem J L
AU - Chamuleau, Steven A J
PY - 2017/5
Y1 - 2017/5
N2 - Organic mitral regurgitation (MR) is a common disorder, and due to the increase in population and its aging, the occurrence of MR is steadily increasing. Current guideline recommendations on the management of asymptomatic severe MR are conflicting and based solely on registries or non-randomized trials in expert heart valve clinics, resulting in a lack of evidence for the best treatment strategy. In this review we will evaluate the latest evidence on diagnostic approaches and treatment strategies for asymptomatic patients without a clear indication for surgical intervention. Implications for management in daily practice are discussed, including an update on the diagnostic approaches that are currently available for the evaluation of MR. For optimal care, it is important that every severe MR patient, including the unidentified patient, is referred to a specialized heart team and is assessed on an individual basis according to the guideline recommendations, experience of the surgical center, and patient characteristics and preferences. Screening and diagnostic approaches need to be performed based on standardized protocols and strict criteria. In addition, specialized valve centers must meet the surgical criteria to indeed guarantee high reparability rates in asymptomatic patients. Awareness among cardiologists and cardiothoracic surgeons, improved guidelines adherence, and a systematic approach, including strict criteria in the management of asymptomatic patients with severe organic MR, will ensure reliable and applicable results in research and daily clinical practice.
AB - Organic mitral regurgitation (MR) is a common disorder, and due to the increase in population and its aging, the occurrence of MR is steadily increasing. Current guideline recommendations on the management of asymptomatic severe MR are conflicting and based solely on registries or non-randomized trials in expert heart valve clinics, resulting in a lack of evidence for the best treatment strategy. In this review we will evaluate the latest evidence on diagnostic approaches and treatment strategies for asymptomatic patients without a clear indication for surgical intervention. Implications for management in daily practice are discussed, including an update on the diagnostic approaches that are currently available for the evaluation of MR. For optimal care, it is important that every severe MR patient, including the unidentified patient, is referred to a specialized heart team and is assessed on an individual basis according to the guideline recommendations, experience of the surgical center, and patient characteristics and preferences. Screening and diagnostic approaches need to be performed based on standardized protocols and strict criteria. In addition, specialized valve centers must meet the surgical criteria to indeed guarantee high reparability rates in asymptomatic patients. Awareness among cardiologists and cardiothoracic surgeons, improved guidelines adherence, and a systematic approach, including strict criteria in the management of asymptomatic patients with severe organic MR, will ensure reliable and applicable results in research and daily clinical practice.
KW - mitral regurgitation
KW - heart surgery
KW - watchful waiting
KW - heart team
KW - guideline recommendations
UR - http://www.scopus.com/inward/record.url?scp=84983503806&partnerID=8YFLogxK
U2 - 10.1097/CRD.0000000000000119
DO - 10.1097/CRD.0000000000000119
M3 - Article
C2 - 27548683
SN - 1061-5377
VL - 25
SP - 110
EP - 116
JO - Cardiology in Review
JF - Cardiology in Review
IS - 3
ER -