Percutaneous Repair or Surgery for Mitral Regurgitation

Feldman, Ted; Foster, Elyse; Glower, Donald D.; Kar, Saibal; Rinaldi, Michael; Fail, Peter S.; Smalling, Richard W.; Siegel, Robert J.; Rose, Geoffrey; Engeron, Eric; Loghin, Catalin; Trento, Alfredo; Skipper, Eric; Fudge, Tommy L.; Letsou, George V.; Massaro, Joseph M.; Mauri, Laura

doi:10.1056/nejmoa1009355

Cited by 1,887 publications

(1,101 citation statements)

References 22 publications

Supporting

Mentioning

1,018

Contrasting

Unclassified

Order By: Relevance

“…As a retrospective calculation of established risk scores (eg, logistic EuroSCORE) was not possible, due to missing variables required for assessment, comparisons to published cohorts are made on the basis of single variables. Compared to the cohort of a randomized trial comparing percutaneous MV‐repair with surgery, patients of our cohort less often had concomitant coronary artery disease but were more than 10 years older 17. Compared to a meta‐analysis of outcomes after MV surgery in octogenarians, the risk profile of our cohort is similar 18…”

Section: Discussionmentioning

confidence: 95%

“…The most established interventional treatment for native MR is the MitraClip ™ therapy (Abbott, Menlo Park, CA), which imitates the surgical technique of the Alfieri stitch by building a bridge between the anterior and posterior mitral leaflet. However, recent reports of MitraClip ™ therapy observed a rate of recurrent severe MR of around 55% at 12 months,17 while re‐operations for recurrent MR were reported as >20% at 4 years of follow‐up in patients treated for degenerative MR 23. Interestingly, a substantial number of patients, initially considered unsuitable for surgical treatment and accepted for MitraClip ™ therapy, underwent MV surgery later on.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…For these frail patients, any cardiac stress may provoke additional cardiac damage with potentially serious complications. PMVR using the MitraClip system requires precise TEE guidance throughout the procedure to achieve exact positioning of the clip 20. Thus, PMVR procedures are commonly performed under GA because of the prolonged TEE time 4, 5.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair

Patzelt

Ulrich

Magunia

et al. 2017

JAHA

View full text Add to dashboard Cite

BackgroundPercutaneous edge‐to‐edge mitral valve repair (PMVR) has become an established treatment option for mitral regurgitation in patients not eligible for surgical repair. Currently, most procedures are performed under general anesthesia (GA). An increasing number of centers, however, are performing the procedure under deep sedation (DS). Here, we compared patients undergoing PMVR with GA or DS.Methods and ResultsA total of 271 consecutive patients underwent PMVR at our institution between May 2014 and December 2016. Seventy‐two procedures were performed under GA and 199 procedures under DS. We observed that in the DS group, doses of propofol (743±228 mg for GA versus 369±230 mg for DS, P<0.001) and norepinephrine (1.1±1.6 mg for GA versus 0.2±0.3 mg for DS, P<0.001) were significantly lower. Procedure time, fluoroscopy time, and dose area product were significantly higher in the GA group. There was no significant difference between GA and DS with respect to overall bleeding complications, postinterventional pneumonia (4% for GA versus 5% for DS), or C‐reactive protein levels (361±351 nmol/L for GA versus 278±239 nmol/L for DS). Significantly fewer patients with DS needed a postinterventional stay in the intensive care unit (96% for GA versus 19% for DS, P<0.001). Importantly, there was no significant difference between DS and GA regarding intrahospital or 6‐month mortality.Conclusions DS for PMVR is safe and feasible. No disadvantages with respect to procedural outcome or complications in comparison to GA were observed. Applying DS may simplify the PMVR procedure.

show abstract

“…Percutaneous mitral valve intervention techniques such as Mitraclip have been recently developed, and when compared to mitral valve surgery in high risk patients have similar operative mortality rates and improvement in symptoms, lower adverse events but increased prevalence of significant residual mitral regurgitation and need for redo procedure at up to 1 year [11]. Between 1 and 4 years, survival, mitral valve dysfunction and re-intervention rates are similar [23].…”

Section: Discussionmentioning

confidence: 99%

“…Due to the perceived high risk, many of these elderly patients remain untreated compared to their younger cohort [6,7]. The decision for intervention has also recently become more complex due to the introduction of percutaneous mitral valve techniques such as the mitraclip [11]. Reviewing the outcomes of mitral valve surgery (MVS) in high risk groups such as the elderly is therefore of great importance to guide clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Contemporary Mitral Valve Surgery for Septuagenarians and Octogenarians

Liao¹,

Wang²,

Harmos³

et al. 2017

MEDJ

View full text Add to dashboard Cite

show abstract

Percutaneous Repair or Surgery for Mitral Regurgitation

Abstract: Although percutaneous repair was less effective at reducing mitral regurgitation than conventional surgery, the procedure was associated with superior safety and similar improvements in clinical outcomes. (Funded by Abbott Vascular; EVEREST II ClinicalTrials.gov number, NCT00209274.).

Cited by 1,887 publications

References 22 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

Comparison of Deep Sedation With General Anesthesia in Patients Undergoing Percutaneous Mitral Valve Repair

Contemporary Mitral Valve Surgery for Septuagenarians and Octogenarians

Contact Info

Product

Resources

About