RESUMO
Atrioventricular regurgitation is frequent in the setting of heart failure. It is due to atrial and ventricular remodelling, as well as rhythmic disturbances and loss of synchrony. Once atrioventricular regurgitation develops, it can aggravate the underlying heart failure, and further participate and aggravate its own severity. Its presence is therefore concomitantly a surrogate of advance disease and a predictor of mortality. Heart failure management, including medical therapy, cardiac resynchronization therapy, and restoration of sinus rhythm, are the initial steps to reduce atrioventricular regurgitation. In the current review, we analyse the current data assessing the epidemiology, pathophysiology, and impact of non-valvular intervention on atrioventricular regurgitation including medical treatment, cardiac resynchronization and atrial fibrillation ablation.
RESUMO
BACKGROUND: Surgical treatment strategies for mitral valve disease have progressively shifted toward repair given the better survival outcomes with this type of intervention. However, valve repairs and valve replacement may require reoperations with time. In the absence of clinical trials assessing the effectiveness of various mitral surgical treatments with time, we propose to develop cost-effectiveness models to compare sequential treatment strategies. METHODS: Three simulation models were carried out to assess the cost-effectiveness of mitral valve repair as first-line treatment, compared with either mechanical or biologic valve replacements. Efficacy data were derived from both the published literature and from a specific clinical cohort of 582 patients treated for this condition. Using the French public health care system perspective, relevant direct costs were derived using a local resource utilization assessment and official costing data sources. RESULTS: Over 10 years, costs per success were significantly lower (p < 0.01) for the mitral valve repair strategy versus biologic or mechanical valve replacements (35,550, 49,492, and 54,634 per success, respectively). Over 20 years, costs per success were significantly lower (p < 0.01) for the mechanical valve replacement strategy compared with the mitral valve repair and biologic valve replacement (94,763, 100,053, and 147,484 per success, respectively). CONCLUSIONS: Considering the increased referral rate in older patients with degenerative mitral valve disease, and their shorter life expectancy, these results show that when medically required and technically practicable, mitral valve repair should be considered as the first-line strategy.