Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction

Wu, Audrey H.; Aaronson, Keith D.; Bolling, Steven F.; Pagani, Francis D.; Welch, Kathy; Koelling, Todd M.

doi:10.1016/j.jacc.2004.09.073

Cited by 630 publications

(215 citation statements)

References 26 publications

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“…Of 682 patients identified, 419 were deemed surgical candidates and 126 of these underwent MVR. In this analysis, there was no clearly demonstrable mortality benefit (or benefit in the combined endpoint of mortality or urgent transplantation) in the surgical group, irrespective of heart failure etiology [47].…”

Section: Effects On Survivalmentioning

confidence: 59%

Pathophysiology of ischemic mitral insufficiency: Does repair make a difference?

2006

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Section: Effects On Survivalmentioning

confidence: 59%

Pathophysiology of ischemic mitral insufficiency: Does repair make a difference?

2006

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“…Revascularisation by coronary artery bypass graft surgery seems to have a certain MR-reducing effect, but additional mitral surgery remains to be defined [25]. Mitral valve repair/annuloplasty might be another surgical option in severe MR, but no mortality benefit has been demonstrated to date [26]. Very recently, the Boston group suggested chordal cutting to relieve chronic ischaemic MR which is still experimental [27].…”

Section: Discussionmentioning

confidence: 99%

Chronic Development of Ischaemic Mitral Regurgitation during Post-Infarction Remodelling

Nixdorff

Klinghammer²,

Wüstefeld³

et al. 2006

Cardiology

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Background/Aims: Mitral regurgitation (MR) following myocardial infarction (MI) may be a (sub)acute complication which independently predicts reduced survival. We sought to evaluate the chronic development of MR as potential consequence of left-ventricular (LV) remodelling, the latter being a long-term process. Methods and Results: Retrospectively, 103 post-MI patients were included according to a standardised Doppler echocardiogram <3 months following MI (20 ± 25 days post-MI) and a follow-up examination >6 months after the first examination (5.1 ± 3.1 years post-MI). Patients were clinically followed up for 7.6 ± 2.7 years. Group I patients were defined as those showing new development or deterioration in one of three grades of MR, and group II those without this criterion (MR grade acute 0.17 vs. 0.27, p = 0.7, and chronic 1.53 vs. 0.19, p < 0.0001). Patient characteristics were similar in respect of age, gender, size and location of infarction. However, group I patients had coronary artery disease with more vessels involved. With regard to echocardiographic parameters of significantly enlarged LV chamber size in group I vs. group II, the significant decrease in LV performance was more pronounced and occurred concomitant with a higher degree of symptomatic congestive heart failure and greater need for heart failure medications in group I. Mortality in group I patients was 39 versus 9% in group II patients (p = 0.0002), approximating an odds ratio of 6.4697 (95% confidence interval: 2.211–18.931). Conclusion: First of all, this retrospective study indicates that MR may be detected in patients after MI during a long-term follow-up most probably due to geometric distortions of LV remodelling resulting in a significantly higher mortality. Since this process is known to become irreversible at a certain point, serial echocardiography may help to detect MR in post-MI patients and thus pave the way for appropriate treatment.

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“…The authors did not demonstrate a survival advantage conferred by MVA compared to medical therapy in patients with mitral regurgitation and LV systolic dysfunction. After excluding patients who were not surgical candidates and controlling for potentially confounding clinical factors, the event-free survival was not significantly different between medically and surgically treated patients [61]. The results of the small studies performed to-date provide the basis for additional large-scale clinical trials, but the absence of these trials led to the recommendations by the ACC/AHA that the "effectiveness of mitral valve repair or replacement is not well established for severe secondary mitral regurgitation in refractory end-stage HF" [2].…”

Section: Mitral Valve Repairmentioning

confidence: 91%

Management of Advanced Heart Failure

Freudenberger

2010

Management of Heart Failure

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Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction

Abstract: In this analysis, there is no clearly demonstrable mortality benefit conferred by MVA for significant MR with severe LV dysfunction. A prospective randomized control trial is warranted for further study of mortality with MVA in this population.

Cited by 630 publications

References 26 publications

Pathophysiology of ischemic mitral insufficiency: Does repair make a difference?

Pathophysiology of ischemic mitral insufficiency: Does repair make a difference?

Chronic Development of Ischaemic Mitral Regurgitation during Post-Infarction Remodelling

Management of Advanced Heart Failure

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