Comparison of Valve Annuloplasty and Replacement for Ischemic Mitral Valve Incompetence

Mićović, Slobodan; Milačić, Petar; Otašević, Petar; Tasić, Nebojša; Bošković, S.; Nežić, Duško; Djukanovic, Bosko

doi:10.1532/hsf98.20081087

Cited by 32 publications

(24 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our operative mortality and post-operative morbidity compare favorably with STS-predicted rates and rates from recent studies comparing outcomes after MV repair and MVR(19, 20). Other recent studies suggest that survival in high-risk populations such as ours may be similar between MVR and MV repair (13, 15, 20). We believe that the preservation of both leaflet chordae is essential in maintaining the left ventricular geometry and function.…”

Section: Discussionsupporting

confidence: 66%

Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: A safe and effective approach to treat a complex problem

Brittain

Goyal

Sample

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

Objective The optimal management of mitral regurgitation (MR) in patients with cardiomyopathy is controversial. Mini-MVR may limit post-operative morbidity and mortality by minimizing recurrent MR. We hypothesized that minimally-invasive fibrillating mitral valve replacement (mini-MVR) with complete chordal sparing would offer a low mortality and halt left ventricular (LV) remodeling in patients with severe cardiomyopathy and severe MR. Methods and Results Between 1/06 - 8/09, 65 patients with LVEF ≤ 35% underwent mini-MVR. Demographic, echocardiographic, and clinical outcomes were analyzed. Results Operative mortality compared to Society for Thoracic Surgery (STS)-predicted mortality was 6.2 versus 6.6%; 5.6 versus 7.4% among patients with LVEF ≤ 20%; and 8.3 versus 17.9% among patients with STS-predicted mortality of ≥ 10%. At median follow-up of 17 months there was no recurrent MR or change in LV dimensions or LVEF, but there was a decrease (p = 0.02) in right ventricular systolic pressure (RVSP). At the first post-operative visit and longest follow-up, NYHA class decreased from 3.0 ± 0.6 to 1.7 ± 0.7 and 2.0 ± 1.0, respectively (both p < 0.0001). Patients with LVEF ≤ 20% and LVEDD ≥ 6.5cm were more likely to meet a composite of death, transplant, or LV assist device insertion (p = 0.046). Conclusions Mini-MVR is safe in advanced cardiomyopathy, and resulted in no recurrent MR, stabilization of LVEF and LV dimensions, and a decrease in RVSP. This mini-MVR fibrillating technique can be used to address severe MR in patients with advanced cardiomyopathy.

show abstract

Section: Discussionsupporting

confidence: 66%

Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: A safe and effective approach to treat a complex problem

Brittain

Goyal

Sample

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…Therefore, recent studies have reported that early mortality of MVR is reducing, and is becoming similar to MVP for patients with IMR and similar EF [21,22]. Our study shows that in a population of high risk patients it is possible to achieve an acceptable and similar early mortality between MVP and MVR group.…”

Section: Discussionsupporting

confidence: 65%

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

Qiu

Chen

et al. 2010

J Cardiothorac Surg

View full text Add to dashboard Cite

BackgroundThis study was undertaken to compare mitral valve repair and replacement as treatments for ischemic mitral regurgitation (IMR) with left ventricular dysfunction (LVD). Specifically, we sought to determine whether the choice of mitral valve procedure affected survival, and discover which patients were predicted to benefit from mitral valve repair and which from replacement.MethodsA total of 218 consecutive patients underwent either mitral valve repair (MVP, n = 112) or mitral valve replacement (MVR, n = 106). We retrospectively reviewed the clinical material, operation methods, echocardiography check during operation and follow-up. Patients details and follow-up outcomes were compared using multivariate and Kaplan-Meier analyses.ResultsNo statistical difference was found between the two groups in term of intraoperative data. Early mortality was 3.2% (MVP 2.7% and MVR 3.8%). At discharge, Left ventricular end-systolic and end-diastolic diameter and left ventricular ejection fraction (LVEF) were improved more in the MVP group than MVR group (P < 0.05), however, in follow-up no statistically significant difference was observed between the MVR and MVP group (P > 0.05). Follow-up mitral regurgitation grade was significantly improved in the MVR group compared with the MVP group (P < 0.05). The Kaplan-Meier survival estimates at 1, 3, and 5 years were simlar between MVP and MVR group. Logistic regression revealed poor survival was associated with old age(#75), preoperative renal insufficiency and low left ventricular ejection fraction (< 30%).ConclusionMitral valve repair is the procedure of choice in the majority of patients having surgery for severe ischemic mitral regurgitation with left ventricular dysfunction. Early results of MVP treatment seem to be satisfactory, but several lines of data indicate that mitral valve repair provided less long-term benefit than mitral valve replacement in the LVD patients.

show abstract

“…One article was excluded because 20% of the patients were hemodynamically unstable and the etiology of MR was ischemic in only 38% of the patients [28]. Nine articles were selected for the final analysis [29][30][31][32][33][34][35][36][37].…”

Section: Resultsmentioning

confidence: 99%

“…To the best of our knowledge, our report is the first metaanalysis focusing specifically on repair versus replacement in [30] 100 0 0 100 0 All or most of the posterior leaflet was preserved during the procedure, and the entire anterior leaflet was excised Milano et al [31] 72 28 NA NA NA Partial or total chordal sparing was frequent Ngaage et al [32] NA some Most 0 The posterior mitral valve leaflet and subvalvular apparatus were preserved, and in some cases both leaflets were preserved Silberman et al [33] 100 0 100 0 0 Al-Radi et al [ [30] 30 a 100 (EF 35%) Silberman et al [33] NA NA 100 (EF < 25%) 100 (EF < 25%) Al-Radi et al [34] NA NA 12 (EF < 25%) 8 (EF < 25%) Mantovani et al [35] 45 (14) 44 (14) 16 (EF < 30%) Reece et al [36] NA NA 19 (EF < 30%) 11 (EF < 30%) Hickey et al [37] 40 (11) 43 (12) NA NA a Median is reported. * p < 0.05 compared to repair.…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation

Vassileva

Boley

Markwell

et al. 2011

European Journal of Cardio-Thoracic Surgery

155

View full text Add to dashboard Cite

The optimal surgical strategy for the management of ischemic mitral regurgitation (IMR) is still debated. The purpose of this study was to perform a meta-analysis summarizing the evidence favoring one technique over another (repair vs replacement). A search of the English literature in PubMed was performed using 'ischemic mitral regurgitation' and 'repair or replacement or annuloplasty' in the title/abstract field. Articles were excluded if they lacked a direct comparison of repair versus replacement, or used Teflon/pericardial strip or suture annuloplasty in >10% of the repairs. Nine articles were selected for the final analysis. All studies except one were relatively recent (2004-2009). The patient characteristics between treatment groups were similar across studies. All studies excluded patients with degenerative etiology and used a rigorous definition of IMR. Most patients had concomitant coronary artery bypass graft. In the patients with mitral valve replacement, at least the posterior and, in many cases, the entire subvalvular apparatus were preserved. Mean ejection fraction and proportion of patients with severe ventricular dysfunction were similar between the repair and replacement groups. The odds ratios for the studies, comparing replacement to repair, ranged from 0.884 to 17.241 for short-term mortality and the hazard ratios ranged from 0.677 to 3.205 for long-term mortality. There was a significantly increased likelihood of both short-term mortality (summary odds ratio 2.667 (95% confidence interval (CI) 1.859-3.817)) and long-term mortality (summary hazard ratio 1.352 (95% CI 1.131-1.618)) for the replacement group compared to the repair group. Based on the meta-analysis of the current relevant literature, mitral valve repair for IMR is associated with better short-term and long-term survival compared to mitral valve replacement. Our conclusion should be interpreted in the context of the inherent limitations of a meta-analysis of retrospective studies including heterogeneity of patient characteristics, which may have influenced the physician's decision to perform mitral valve repair or replacement. In the absence of any published randomized studies, mitral procedure selection should be individualized.

show abstract

Comparison of Valve Annuloplasty and Replacement for Ischemic Mitral Valve Incompetence

Cited by 32 publications

References 17 publications

Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: A safe and effective approach to treat a complex problem

Minimally invasive fibrillating mitral valve replacement for patients with advanced cardiomyopathy: A safe and effective approach to treat a complex problem

Is mitral valve repair superior to replacement for chronic ischemic mitral regurgitation with left ventricular dysfunction?

Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation

Contact Info

Product

Resources

About