Effect of mitral valve repair versus replacement on left ventricular rotational deformation: a study using specle tracking echocardiography

Candan, Özkan; Özdemir, Nihal; Aung, Soe Moe; Geçmen, Çetin; Doğan, Cem; Omaygenç, Onur; Kaymaz, Ci̇hangi̇r

doi:10.1093/eurheartj/eht308.1844

Cited by 9 publications

(8 citation statements)

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“…15 Correspondingly, we observed improved LV function after MV-repair, despite a higher degree of residual MR. Although LV function post MVR did not deteriorate, as described previously, 26,27 which may be a result of preservation of the subvalvular apparatus, LV function did not improve, despite optimal function of the replaced valves. Possibly, future strategies to implant a MV interventionally may overcome this problem as the entire subvalvular apparatus will be preserved with less lateral chordal displacement.…”

Section: Functionsupporting

confidence: 73%

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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BackgroundBecause of demographic changes, a growing number of elderly patients present with mitral valve (MV) disease. Although mitral valve repair (MV‐repair) is the “gold standard” treatment for MV disease, in elderly patients, there is controversy about whether MV‐repair is superior to mitral valve replacement. We reviewed results after MV surgery in elderly patients treated over the past 20 years.Methods and ResultsOur in‐hospital database was explored for patients who underwent MV surgery between 1994 and 2015. Survival data, obtained from the National Health Service central register, were complete for all patients. Of 1776 patients with MV disease, 341 were aged ≥75 years. Patients with repeat cardiac surgery, endocarditis, and concomitant aortic valve replacement were excluded. This yielded 221 MV‐repair and 120 mitral valve replacement patients. Concomitant procedures included coronary artery bypass grafting in 135 patients (39.6%) and tricuspid valve surgery in 50 patients (14.7%). Thirty‐day mortality was 5.4% (MV‐repair) versus 9.2% (mitral valve replacement, P=0.26). Overall 1‐ and 5‐year survival was 90.7%, 74.2% versus 81.3%, 61.0% (P<0.01). Median survival after MV‐repair was 7.8 years, close to 8.5 years (95% CI: 8.2–9.4) in the age‐matched UK population (ratio 0.9). Rate of re‐operation for MV‐dysfunction was 2.3% versus 2.5% (mitral valve replacement, P=1.0). After propensity matching, patients after MV‐repair still had improved survival at 1, 2, and 5 years (93.4%, 91.6%, 76.9% versus 77.2%, 75.2%, 58.7%, P=0.03).ConclusionsExcellent outcomes can be achieved after MV surgery in elderly patients. Long‐term survival is superior after MV‐repair and the re‐operation rate is low. MV‐repair should be the preferred surgical approach in elderly patients.

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Section: Functionsupporting

confidence: 73%

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Silaschi

Chaubey

Aldalati

et al. 2016

JAHA

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“…In the present study, we did not specially explore the potential factor accounting for the improved outcomes after MVP; however, they can be summarized from the other available evidence. First of all, MVP allows better preservation of normal mitral or subvalvular apparatus than MVR that is important for ventricular contraction, thereby improving left ventricular function and remodeling (21)(22)(23). In addition, it has been suggested that there are fewer thromboembolic events and life-threatening hemorrhages in patients with MVP than those with MVR (24), thus reducing the deaths from these causes.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

Shang¹,

Lü²,

Liu³

et al. 2017

J. Thorac. Dis.

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Background: Although mitral valve repair (MVP) is generally accepted as the standard treatment for mitral valve disease, in older patients, there is increasing debate about whether MVP is superior to mitral valve replacement (MVR). We, therefore, performed a meta-analysis to compare MVP vs. MVR in the elderly population. 0.56-0.86). In addition, our study also demonstrated improved 1-year (RR: 1.16, 95% CI: 1.08-1.24) and 5-year (RR: 1.26, 95% CI: 1.13-1.41) survival rates following MVP. There was no difference in reoperations between these two surgery approaches. Conclusions:The present meta-analysis indicates that elderly patients who receive MVP have better early and late outcomes than those undergoing MVR. MVP may be the preferred strategy for mitral valve surgery in the elderly population.

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“…The survival curves for the 2 groups after 1 year were separated but parallel, highlighting the impact of initial excess mortality in the replacement group. Furthermore, previous studies [4,17,18] have reported that the LV ejection fraction after MV repair progressively improved until 1 year of follow-up, whereas there was no significant improvement after MV replacement despite the preservation of the subvalvular apparatus. This is a further explanation of the fact that the overall survival and cardiac-related death remained stable after 1 year postoperatively.…”

Section: Discussionmentioning

confidence: 95%

Surgical Treatment of Degenerative Mitral Valve Regurgitation in the Elderly: Comparison of Early and Long-Term Outcomes Using Propensity Score Matching Analysis

Lee

Kim

Choi

et al. 2018

Korean J Thorac Cardiovasc Surg

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BackgroundIt is unclear whether mitral valve (MV) repair for degenerative mitral regurgitation (MR) provides the same advantages in the elderly that it does in the general population.MethodsFrom 1994 to 2016, 188 elderly patients (mean age, 68.3±5.50 years) underwent MV repair (n=153) or MV replacement (n=35) for primary degenerative MR. Early and long-term outcomes were compared before and after propensity score matching (PSM).ResultsBefore PSM, there was a significant difference in operative mortality (p=0.011). Overall survival and freedom from cardiac-related death (CRD) at 5, 10, and 15 years were significantly higher in patients who underwent MV repair (p=0.039 and p=0.007, respectively). In the multivariable analysis, MV replacement was an independent risk factor of CRD. After PSM, operative mortality was not significantly lower in patients who underwent MV repair (p=0.125). Overall survival and freedom from CRD at 5, 10, and 15 years showed no significant difference between the 2 groups in the PSM cohort (p=0.207, p=0.47, respectively). There was no significant difference in freedom from reoperation before or after PSM (p=0.963 and p=0.575, respectively).ConclusionMV repair for primary degenerative MR might be a valid option in the elderly population if successful repair is possible.

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Effect of mitral valve repair versus replacement on left ventricular rotational deformation: a study using specle tracking echocardiography

Cited by 9 publications

References 0 publications

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Is Mitral Valve Repair Superior to Mitral Valve Replacement in Elderly Patients? Comparison of Short‐ and Long‐Term Outcomes in a Propensity‐Matched Cohort

Mitral valve repair versus replacement in elderly patients: a systematic review and meta-analysis

Surgical Treatment of Degenerative Mitral Valve Regurgitation in the Elderly: Comparison of Early and Long-Term Outcomes Using Propensity Score Matching Analysis

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