Surgical referral in symptomatic mitral regurgitation: greater compliance with guidelines is needed

Significant valvular heart disease is a common public health problem with an overall prevalence of 2.5% which increases to 13% of the population aged 75 years and older.1 It will become an increasingly important problem as the baby-boomer population ages in the western world in the coming decades, because the burden of all forms of valve disease increases with age. Mitral regurgitation (MR) is the most common form of valve disease, and patients with severe MR can remain asymptomatic for many years.1 Once symptoms develop, these patients should undergo valve surgery.2 The study by Mirabel et al .3 provides important information as to why some symptomatic patients with severe MR are not referred for surgery. Their findings are based on the prospective Euro Heart Survey of patients with valvular heart disease conducted in 92 European centres in 2001. They examined the clinical characteristics and outcomes of patients with symptomatic severe MR (3+ and 4+) who were not referred for surgery and these patients accounted for about half of the 396 patients with severe symptomatic MR. Of those who underwent surgery, 41% had mitral valve repair. Many of the characteristics of patients not referred for surgery … *Corresponding author. Tel: +1 613 761 4189; fax: +1 613 761 4170. E-mail address : kchan{at}ottawaheart.ca