Early surgical intervention or watchful waiting for the management of asymptomatic mitral regurgitation: a systematic review and meta-analysis.

摘要: Background: Discordance between studies drives continued debate regarding the best management of asymptomatic severe mitral regurgitation (MR). The aim present study was to conduct a systematic review and meta-analysis plans for MR, compare effectiveness strategy early surgery watchful waiting. Methods: A performed using Preferred Reporting Items Systematic Reviews Meta-analyses (PRISMA) guidelines. Studies were excluded if they: (I) lacked waiting cohort; (II) included symptomatic patients; or (III) etiologies other than degenerative valve disease. primary outcome all-cause mortality at 10 years. Secondary outcomes operative mortality, repair rate, repeat surgery, development new atrial fibrillation. Results: Five observational eligible three in pooled analysis. In patients without class I triggers (symptoms ventricular dysfunction), analysis revealed significant reduction long-term with an approach [hazard ratio (HR) =0.38; 95% confidence interval (CI): 0.21-0.71]. This survival benefit persisted sub-group limited II (atrial fibrillation pulmonary hypertension) [relative risk (RR) =0.85; CI: 0.75-0.98]. Aggregate rates did not differ treatment arms (0.7% vs . 0.7% waiting). However, significantly higher achieved cohorts (RR =1.10; 1.02-1.18). Conclusions: Despite disagreement individual studies, demonstrates that may improve increase likelihood compared waiting. Early also when instituted prior triggers.