Overblown fears about surgical risk and lack of awareness about the risk of not operating are among the reasons only half of eligible patients were referred for mitral valve repair, according to a study in the Aug. 25 issue of the Journal of the American College of Cardiology.
Among those who were not operated on, three-fourths of patients met at least one indication for surgery, according to guidelines from the American College of Cardiology (ACC) and the American Heart Association (AHA).
"In general, cardiologists tend to overestimate the risks of surgery and underestimate the potential benefits for patients," said lead author David S. Bach, professor of internal medicine at the University of Michigan Medical School and cardiologist at the University of Michigan Cardiovascular Center.
At a single large tertiary medical center, the researchers retrospectively reviewed patients who had moderate-to-severe or severe mitral regurgitation based on echocardiographic imaging during 2005. They identified 300 patients with significant mitral regurgitation, including 188 with functional mitral regurgitation and 112 with organic mitral regurgitation.
Researchers found that mitral surgery was performed in 30 of 188 patients with functional MR, mostly to treat heart failure or during another cardiac surgical procedure. Of the 112 patients with severe organic mitral valve regurgitation, only half had surgery.
The authors noted that surgical risk scores were no different among patients who underwent surgery compared to those who did not.
According to Bach and colleagues, existing data show deaths among patients undergoing mitral valve surgery have decreased dramatically in recent years, making the procedure a feasible option.
"I think there remains something of a bias in medicine and cardiology that surgery is risky, and surgery is a failure of our ability to manage the patient medically," Bach said. "Mitral valve diseases are not as benign as they were once thought to be, and surgery is not as morbid as it was thought of in the past."
A review of patient charts, according to the authors, showed the most common reasons for not referring patients for surgery were stable heart functioning, an absence of symptoms or presence of other major health problems.
Bach suggested that cardiologists become more familiar with guideline recommendations and the data on which they are based, discuss options more fully with patients, and when possible, involve a surgeon in consultation.
Edwards Lifesciences provided the funding for this study.