Comparative Morbidity of Mitral Valve Repair versus Replacement for Mitral Regurgitation with and without Coronary Artery Disease

Cohn, Lawrence H.; Kowalker, Wendy; Bhatia, Satinder J.S.; DiSesa, Verdi J.; John-Sutton, Martin St.; Shemin, Richard J.; Collins, John J.

doi:10.1016/s0003-4975(10)62463-0

Cited by 113 publications

(21 citation statements)

References 15 publications

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“…Studies with follow-up periods of five 26,28 , eight 35 and 16 34 years, reported survival rates of respectively, 90 to 98.8±1.2%, 88±4%, and 76.1±-3.1%. It is common to find valve repair leading to a higher survival rate in comparison with valve replacement 37 .…”

Section: Discussionmentioning

confidence: 99%

“…Long-term results showed ventricular function restored to normal levels, significantly improved survival ratios in particular following solely mitral procedures 34 , which in the present work were performed in 71.8% of the patients. Associated with this was the introduction of various valve repair techniques 13,21,40,41 as well as recognition of the problems caused by valve replacement procedures like prosthesis degeneration, infection, transvalvular gradients, paravalvular leaking, hemolysis, and thromboembolic events 8,37 .…”

Section: Discussionmentioning

confidence: 99%

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Mitral valve repair with a malleable bovine pericardium ring

Volpe¹,

Braile²,

Vieira³

et al. 2000

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mitral valve repair with a malleable bovine pericardium ring

Volpe¹,

Braile²,

Vieira³

et al. 2000

Arq. Bras. Cardiol.

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“…The resultant chronic MR and the consequent changes in LV volume, mass, geometry, and function closely parallel those seen in clinical disease. [8][9][10][11][12][13]19,20,[25][26][27][28]40 Changes in diastolic function were assessed in a serial longitudinal fashion; baseline function was compared with changes in function caused by chronic MR and then after MVR in sure gradient and LV stress at mitral valve opening by guest on May 13, 2018 http://circ.ahajournals.org/ Downloaded from the same animal. The hemodynamic and mechanical measurements made using simultaneous echocardiography and catheterization allowed assessment of changes in both diastolic function itself and many (but not all) of the determinants or mechanisms causing these changes in diastolic function.…”

Section: Diastolic Functionmentioning

confidence: 99%

Changes in diastolic function during development and correction of chronic LV volume overload produced by mitral regurgitation.

et al. 1993

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Background. Mitral regurgitation (MR) causes an augmentation in left ventricular (LV) diastolic function, increasing early diastolic filling rate and decreasing LV stiffness. Whether these changes in diastolic function persist, return to normal, or become abnormal after mitral valve replacement (MVR) is unknown.Methods and Results. Simultaneous LV echocardiography and catheterization studies were performed in six dogs in the baseline state (baseline), 3 months after creation of MR (chronic MR), and 3 months after MVR. Chronic MR caused LV dilation (end-diastolic dimension increased from 4.5±0.1 cm in baseline to 5.8+0.1 cm in chronic MR,p<0.05) and eccentric LV hypertrophy (LV-to-body weight ratio increased from 3.6±0.2 g/kg in baseline to 4.9±0.4 g/kg in chronic MR, p<0.05). Chronic MR caused an increase in LV early diastolic filling rate (peak rate of increase in minor-axis dimension increased from 11±1 cm/sec in baseline to 18+1 cm/sec in chronic MR,p<0.05), did not change the time constant of myocardial relaxation (T was 31±4 msec in baseline and 30±2 msec in chronic MR), and caused a decrease in the modulus of regional chamber stiffness from 7.7± 1.2 in baseline to 2.4±0.03 in chronic MR,p<0.05. MVR caused the resolution of LV dilation (end-diastolic dimension returned to normal [4.8±0.2 cm]), but three months after MVR, regression of LV hypertrophy was incomplete (LV-to-body weight ratio remained

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“…Many reports [24][25][26][27][28][29] have demonstrated better LV function and actuarial analysis of the long term results in MVP than in MVR. Galloway [24] reported that the operative risk and late survival obtained after MVP were at least equivalent to those obtained after MVR.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Left Ventricular Function after Surgery for Pure Mitral Regurgitation Using Dobutamine-stress Echocardiography. Should the Mitral Complex Be Preserved?

Oda

1999

Kurume Med. J.

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Summary: To evaluate the importance of preserving the mitral complex, clinical outcomes and postoperative left ventricular (LV) functions of 175 patients with pure mitral regurgitation (MR) were analyzed. They were divided into three groups; patients who had conventional mitral valve replacement (cMVR; n=47), posterior mitral leaflet preserved MVR (pMVR; n=66) or mitral valvuloplasty (MVP; n=62). There was no operative death or hospital death in this study. The actuarial survival rate was 85.2% in cMVR, 78.5% in pMVR, and 84.7% in MVP at 10 years after operation. The actuarial freedom from reoperation 10 years postoperatively was 100% in cMVR, 97.9% in pMVR, 85.8% in MVP. The actuarial freedom from thromboembolism (TE) at 10 years was 92.2% in cMVR, 87.1% in pMVR, 93.5% in MVP. Freedom from all types of events including non-cardiac death was 78.3% in cMVR, 64.8% in pMVR, 65.3% in MVP at 10 years, respectively. Pre-and postoperative LV function was evaluated using echocardiography. Patients with MVP had better LV performance than those with MVR. However, there was no significant difference between the cMVR and pMVR groups. For further estimation of postoperative LV function, dobutaminestress echocardiography (DSE) was performed. The results of DSE revealed that the LV contractility in MVP was obviously better than those in MVR groups especially in systole. The change in ejection fraction (EF) from baseline to peak dobutamine stress in the pMVR group was significantly greater than in cMVR. This study supports the concept that the preservation of continuity between the mitral annulus and papillary muscle plays an important role in clinical outcome and postoperative LV function. In conclusion, MVP should be a first choice as an operative method for pure MR when technically feasible. When it is impossible to perform MVP, pMVR, not cMVR, should be the next choice. This study suggests that preservation of papillary muscle-mitral annular continuity during mitral valve surgery for pure MR is beneficial to LV systolic function.

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Comparative Morbidity of Mitral Valve Repair versus Replacement for Mitral Regurgitation with and without Coronary Artery Disease

Cited by 113 publications

References 15 publications

Mitral valve repair with a malleable bovine pericardium ring

Mitral valve repair with a malleable bovine pericardium ring

Changes in diastolic function during development and correction of chronic LV volume overload produced by mitral regurgitation.

An Evaluation of Left Ventricular Function after Surgery for Pure Mitral Regurgitation Using Dobutamine-stress Echocardiography. Should the Mitral Complex Be Preserved?

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