Mitral Repair Is Superior to Replacement When Associated With Coronary Artery Disease

Reece, T. Brett; Tribble, Curtis G.; Ellman, Peter I.; Maxey, Thomas S.; Woodford, Randall L.; Dimeling, George; Wellons, Harry A.; Crosby, Ivan K.; Kern, John A.; Krön, Irving L.

doi:10.1097/01.sla.0000124297.40815.86

Cited by 81 publications

(54 citation statements)

References 17 publications

(23 reference statements)

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“…Some studies reported that unadjusted survival is lower with MVR than with MVRp in patients with ischemic MR. 12,24,25 However, as also observed in the present study (Table 1), patients undergoing MVR are frequently older, sicker, and have more comorbidities than those with MVRp, which may explain survival differences between the 2 treatment groups. To this effect, Cohn et al 26 demonstrated that the outcome of patients with ischemic MR is more related to the patient's clinical status rather than to the type of procedure (MVR versus MVRp).…”

Section: Discussioncontrasting

confidence: 37%

Mitral Repair versus Replacement for Ischemic Mitral Regurgitation

Magné

Girerd²,

Sénéchal³

et al. 2009

Circulation

138

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Background-When compared to mitral valve replacement (MVR), mitral valve repair (MVRp) is associated with better survival in patients with organic mitral regurgitation (MR). However, there is an important controversy about the type of surgical treatment that should be used in patients with ischemic MR. The objective of this study was to compare the postoperative outcome of MVRp versus MVR in patients with ischemic MR. Methods and Results-Preoperative and operative data of 370 patients with ischemic MR who underwent mitral valve surgery were prospectively collected and retrospectively analyzed. MVRp was performed in 50% of patients (nϭ186) and MVR in 50% (nϭ184). Although operative mortality was significantly lower after MVRp compared to MVR (9.7% versus 17.4%; Pϭ0.03), overall 6-year survival was not statistically different between procedures (73Ϯ4% versus 67Ϯ4%; Pϭ0.17). After adjusting for other risk factors and propensity score, the type of procedure (MVRp versus MVR) did not come out as an independent predictor of either operative (OR, 1.5; 95% CI, 0.7-2.9; Pϭ0.34) or overall mortality (HR, 1.2; 95% CI, 0.7-1.9; Pϭ0.52). Conclusion-As opposed to what has been reported in patients with organic MR, the results of this study suggest thatMVRp is not superior to MVR with regard to operative and overall mortality in patients with ischemic MR. These findings provide support for the realization of a randomized trial comparing these 2 treatment modalities. (Circulation. 2009;120[suppl 1]:S104-S111.)

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Section: Discussioncontrasting

confidence: 37%

Mitral Repair versus Replacement for Ischemic Mitral Regurgitation

Magné

Girerd²,

Sénéchal³

et al. 2009

Circulation

138

View full text Add to dashboard Cite

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“…Previous studies generally reported that unadjusted survival is lower with MVR than with MVA [91,92,93]. However, patients undergoing MVR are frequently older, sicker and have more comorbidities than those with MVA, which may explain survival differences between the 2 treatment groups.…”

Section: Treatment Of Ischemic Mrmentioning

confidence: 58%

Ischemic Mitral Regurgitation: A Complex Multifaceted Disease

et al. 2008

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Ischemic mitral regurgitation (MR) is a complex multifactorial disease that involves global and regional left ventricular remodeling as well as dysfunction and distortion of the components of the mitral valve including the chordae, annulus and leaflets. This is a frequent (13–59%) complication of myocardial infarction, which is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, that is, restrictive annuloplasty combined with coronary artery bypass graft, emphasize the need to develop alternative or concomitant surgical techniques that directly target the causal mechanisms of the disease. A comprehensive assessment of mitral valve configuration and left ventricular geometry and function prior to surgery as well as an accurate quantification of MR severity at rest and during exercise may help improve patient risk stratification and better individualize the surgical strategy based on the patient’s specific characteristics. The purpose of this review is to summarize the current state of knowledge with regard to the definition, prevalence, mechanisms, outcome and treatment of ischemic MR.

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“…In patients with functional IMR, several studies have compared outcomes after repair and replacement. Unadjusted hospital mortality is generally lower with repair than with replacement [1,[55][56][57]. However, patients receiving mitral valve replacement are frequently higher risk patients, and this explains in part early survival differences.…”

Section: Revascularization With Mitral Valve Replacementmentioning

confidence: 99%

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Gillinov

2006

Heart Fail Rev

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Ischemic mitral regurgitation (IMR) is common in patients with coronary artery disease. While it is well-known that IMR exerts a graded effect upon survival-the greater the degree of IMR, the lower the survival-the indications for surgical treatment and the choice of surgical procedure (repair versus replacement) are controversial. In patients with mild to moderate IMR, the benefit of a mitral valve procedure has not been demonstrated, and surgical practice varies. In patients with severe IMR, mitral valve surgery is the norm, but guidelines for choosing between valve repair and valve replacement do not exist. Furthermore, the survival impact of mitral valve surgery in patients with severe IMR is uncertain. When patients with severe IMR undergo mitral valve surgery, undersized annuloplasty results in durable repair in 70% to 85% of cases. Newly-developed adjunctive repair techniques may further improve results. Currently, mitral valve repair is the procedure of choice in the majority of patients having surgery for severe IMR. However, the most severely ill patients and those with certain echocardiographic characteristics (e.g. severe bileaflet tethering) should be treated with bioprosthetic mitral valve replacement rather than repair.

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Mitral Repair Is Superior to Replacement When Associated With Coronary Artery Disease

Cited by 81 publications

References 17 publications

Mitral Repair versus Replacement for Ischemic Mitral Regurgitation

Mitral Repair versus Replacement for Ischemic Mitral Regurgitation

Ischemic Mitral Regurgitation: A Complex Multifaceted Disease

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

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