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“Early Surgical” Mitral Regurgitation: View of Cardiologist A/Prof Phạm Mạnh Hùng, MD.PhD FACC.FESC Director – Cardiac Cath Lab VNHI Secretary General - VNHA PRIMARY  Pathology >=1 components (leaflets, chordae tendineae, papillary muscles, annulus):    Prolapse Rheumatic heart disease IE, connective tissue disor- ders,, cleft mitral valve, radiation heart disease… SECONDARY  Valve normal, LV dysfunction:   Ischemic HD Dilated CM MR Etiology Normal Degenerative MR (Prolapse) Degenerative MR (Flail) Functional MR Ischemic vs nonischemic Prognosis of Untreated MR Mitral Regurgitation Natural History of Severe Asymptomatic MR Asymptomatic with normal LV function 100 Alive, Asymptomatic without Surgery (%) Medicare data 80 Kang Sarano * Rosenhek Average hospital mortality: 8.8% * * 60 40 20 • Low volume centers: 13.0% Grigioni • High volume centers: Rosen 6.0% Data from national Medicare database 1994-1999 10 Time (years) Bonow, J Am Coll Cardiol 2013;61:693-701 684 hospitals 142,488 AVRs Rosen et al Am J Cardiol 1994;74:374-380 Sarano et al N Engl J Med 2005;352:875-883 Rosenhek et al Circulation 2006;113:2238-2244 Grigioni et J Am Coll Cardiol Img 2008;1:133-141 Kang et al Circulation 2009;119:797-804 Mitral Regurgitation Natural History of Severe Asymptomatic MR Alive, Asymptomatic without Heart Failure or AF (%) Survival without Heart Failure or Atrial Fibrillation 100 Medicare data 80 ERO [...]... Dysfunction ? Goals of Treatment • Functional MR: -Slow or reverse remodeling -Improve symptoms/functional class -Decrease hospitalizations for CHF -Increase time to transplant or VAD (slow progression to advanced HF) -Improve survival Medical Therapy • Medical treatments proven effective for treating the ventricular disease in large RCTs also reduce the severity of functional MR in some patients • Data directly