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Surgery for asymptomatic degenerative aortic and mitral valve disease

Nature Reviews Cardiology volume 8, pages 173–177 (2011)Cite this article

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Abstract

Degenerative valvular heart disease, the most common form of valve disease in the Western world, can lead to aortic stenosis (AS) or mitral regurgitation (MR). In current guidelines for the management of patients with degenerative valvular disease, surgical intervention is recommended at the onset of symptoms or in the presence of left ventricular systolic impairment. Whether surgery is appropriate for asymptomatic patients remains a controversial issue. We argue the case for early pre-emptive intervention in selected, asymptomatic individuals with AS or MR, drawing on contemporary perioperative data, predictors of disease progression, and studies of the natural history of degenerative valvular heart disease.

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Figure 1: Kaplan–Meier event-free survival rate among patients with very severe aortic stenosis.
Figure 2: Survival free of cardiac-related death among 197 consecutive asymptomatic patients receiving conventional treatment for asymptomatic very severe aortic stenosis.
Figure 3: Postoperative survival data for patients undergoing mitral vale repair.
Figure 4: Surgical management of valvular heart disease.

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Authors and Affiliations

  1. Zena and Michael A. Wiener Cardiovascular Institute, and the Marie-Jose and Henry R. Kravis Cardiovascular Health Center, The Mount Sinai School of Medicine, 1 Gustave L. Levy Place, New York, 10029, NY, USA

    Prashant Vaishnava, Valentin Fuster & Martin Goldman

  2. Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, 645 North Michigan Avenue, Chicago, 60611, IL, USA

    Robert O. Bonow

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  1. Prashant Vaishnava
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  2. Valentin Fuster
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  3. Martin Goldman
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  4. Robert O. Bonow
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Contributions

P. Vaishnava researched the data for the article, contributed substantially to the discussion of content, wrote the article, and reviewed and edited the manuscript before submission and after peer-review. V. Fuster, M. Goldman, and R. O. Bonow provided substantial contributions to the discussion of the content and to review and editing of the manuscript before submission and after peer-review.

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Correspondence to Prashant Vaishnava.

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Competing interests

R. O. Bonow is a consultant on transcatheter valve technologies for Edwards LifeSciences. The other authors declare no competing interests.

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Vaishnava, P., Fuster, V., Goldman, M. et al. Surgery for asymptomatic degenerative aortic and mitral valve disease. Nat Rev Cardiol 8, 173–177 (2011). https://doi.org/10.1038/nrcardio.2010.203

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