Early surgical repair of severe mitral valve regurgitation from flail leaflets improved long-term outcomes compared with waiting until symptoms or other surgical indications appeared, a registry study showed.

Repair within three months of diagnosis in absence of traditional class I indications was associated with roughly half the mortality risk of watchful waiting, for 10-year survival rates of 86 percent versus 69 percent (P<0.001), Rakesh M. Suri, MD, DPhil, of the Mayo Clinic in Rochester, Minn., and colleagues found.

Substantially fewer early surgery patients developed heart failure (7 percent versus 23 percent at 10 years, P<0.001), the researchers reported in the Aug. 14 issue of the Journal of the American Medical Association.

Those benefits held even in the absence of traditional class I triggers for surgery and didn't come with any extra risk of atrial fibrillation overall, the group noted.

The findings will only apply to a minority of patients typically seen in clinical practice now, as most are referred at symptom onset or when serial imaging shows early left ventricular dysfunction, Catherine M. Otto, MD, of the University of Washington School of Medicine in Seattle, noted in an accompanying editorial.

The six tertiary referral centers (in Belgium, France, Italy, and the U.S.) participating in the registry averaged only seven such asymptomatic patients per year, she pointed out.

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