Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease

Gillinov, A. Marc; Faber, Cristiano; Houghtaling, Penny L.; Blackstone, Eugene H.; Lam, Buu-Khanh; Diaz, Ramon; Lytle, Bruce W.; Sabik, Joseph F.; Cosgrove, Delos M.

doi:10.1016/s0022-5223(02)73274-1

Cited by 95 publications

(69 citation statements)

References 28 publications

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“…16 The linearized rates of these complications are low; nevertheless, recent reports focusing on mitral valve surgery indicate that valve replacement is associated with long-term survival inferior to predicted levels, whereas mitral repair improves survival to predicted levels. [25][26][27][28] For the mitral valve, it is thus accepted that repair reduces valverelated morbidity and mortality, whereas there are no comparable data available at this time for aortic valve reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Aortic Valve Repair Using a Differentiated Surgical Strategy

Langer¹,

Aicher²,

Kissinger³

et al. 2004

Circulation

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Background-Reconstruction of the aortic valve for aortic regurgitation (AR) remains challenging, in part because of not only cusp or root pathology but also a combination of both can be responsible for this valve dysfunction. We have systematically tailored the repair to the individual pathology of cusps and root. Methods-Between October 1995 and August 2003, aortic valve repair was performed in 282 of 493 patients undergoing surgery for AR and concomitant disease. Root dilatation was corrected by subcommissural plication (nϭ59), supracommissural aortic replacement (nϭ27), root remodeling (nϭ175), or valve reimplantation within a graft (nϭ24). Cusp prolapse was corrected by plication of the free margin (nϭ157) or triangular resection (n ϭ36), cusp defects were closed with a pericardial patch (nϭ16). Additional procedures were arch replacement (nϭ114), coronary artery bypass graft (nϭ60) or mitral repair (nϭ24). All patients were followed-up (follow-up 99.6% complete), and cumulative follow-up was 8425 patient-months (mean, 33Ϯ27 months). Results-Eleven patients died in hospital (3.9%). Nine patients underwent reoperation for recurrent AR (3.3%). Actuarial freedom from AR grade ՆII at 5 years was 81% for isolated valve repair, 84% for isolated root replacement, and 94% for combination of both; actuarial freedom from reoperation at 5 years was 93%, 95%, and 98%, respectively. No thromboembolic events occurred, and there was 1 episode of endocarditis 4.5 years postoperatively. Conclusions-Aortic valve repair is feasible even for complex mechanisms of AR with a systematic and individually tailored approach. Operative mortality is low and mid-term durability is encouraging.

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Section: Discussionmentioning

confidence: 99%

Aortic Valve Repair Using a Differentiated Surgical Strategy

Langer¹,

Aicher²,

Kissinger³

et al. 2004

Circulation

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“…However, CABG alone is usually insufficient and leaves many patients with significant residual MR, and these patients would benefit from concomitant MV repair at the time of the CABG. [623][624][625][626][627][633][634][635][636][637][638][639][640][641][642] Mitral annuloplasty alone with a downsized annuloplasty ring is often effective at relieving MR. 637,638,641 In severe MR secondary to acute myocardial infarction, hypotension and pulmonary edema often occur. Severe MR occurs in 6% to 7% of patients with cardiogenic shock.…”

Section: Ischemic Mitral Regurgitationmentioning

confidence: 99%

“…The best operation for ischemic MR is controversial, 645,646 but MV repair with an annuloplasty ring is the best approach in most instances. 624,627,[633][634][635][636][637][638][639][640][641][642] …”

Section: Ischemic Mitral Regurgitationmentioning

confidence: 99%

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Bonow¹,

Carabello²,

Chatterjee³

et al. 2008

Circulation

916

259

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“…4,11 However, morbidity, mortality, and late recurrent MR limit widespread application of surgical repair. [12][13][14][15][16] Although surgical mitral repair may be sophisticated and complex, most repairs currently consist of simple annuloplasty. 17 Should percutaneous repair prove efficacious and safe, then it might have a potential role early in the natural history of MR.…”

Section: Editorials Pp 771 and 774 Clinical Perspective P 855mentioning

confidence: 99%

Percutaneous Transvenous Mitral Annuloplasty

et al. 2006

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Background-Mitral annuloplasty is the most common surgical procedure performed for ischemic mitral regurgitation (MR). Surgical mitral annuloplasty is limited by morbidity, mortality, and MR recurrence. We evaluated the safety and feasibility of a transvenous catheter-delivered implantable device to provide a percutaneous alternative to surgical mitral annuloplasty. Methods and Results-Five patients with chronic ischemic MR underwent percutaneous transvenous implantation of an annuloplasty device in the coronary sinus. Implantation was successful in 4 patients. Baseline MR in the entire group was grade 3.0Ϯ0.7 and was reduced to grade 1.6Ϯ1.1 at the last postimplantation visit when the device was intact or the last postprocedural visit in the patient in whom the device was not successfully implanted. Separation of the bridge section of the device occurred in 3 of 4 implanted devices and was detected at 28 to 81 days after implantation. There were no postprocedural device-related complications. Conclusions-Percutaneous

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Repair versus replacement for degenerative mitral valve disease with coexisting ischemic heart disease

Abstract: In patients with degenerative mitral valve and ischemic heart diseases, mitral valve repair confers a survival advantage over replacement that becomes evident about 2 years after the operation.

Cited by 95 publications

References 28 publications

Aortic Valve Repair Using a Differentiated Surgical Strategy

Aortic Valve Repair Using a Differentiated Surgical Strategy

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Percutaneous Transvenous Mitral Annuloplasty

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