Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation

Bouchard, Denis; Jensen, Henrik; Carrier, Michel; Demers, Philippe; Pellerin, Michel; Perrault, Louis P.; Lambert, Jean

doi:10.1016/j.jtcvs.2013.05.024

Cited by 47 publications

(67 citation statements)

References 18 publications

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“…The mitral regurgitation in patients enrolled in this trial was entirely ischemic in nature and was severe (in 96% of the patients) according to integrative echocardiographic criteria, and the baseline ejection fraction was similar to that reported previously. 33 The mean effective regurgitant orifice area among patients in our study was 0.4 cm 2 , which qualifies as severe mitral regurgitation according to the recent guidelines of the European Society of Cardiology, which provide a threshold of 0.2 cm 2 . The patients in our study had a relatively long length of stay during the index hospitalization, with the majority of the stay occurring after surgery.…”

Section: Discussionmentioning

confidence: 55%

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

et al. 2014

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Background Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. Methods We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. Results At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, −6.6 and −6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. Conclusions We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.)

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Section: Discussionmentioning

confidence: 55%

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

et al. 2014

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“…Some studies had reported that combined mitral valve annuloplasty (MVA) and coronary artery bypass grafting (CABG) could reduce IMR immediately after surgery and at follow-up 2,3 ; however, others have shown that recurrent IMR did occur after CABG plus MVA, and no benefit for long-term survival was observed. 4,5 A recent randomized trial showed no greater LV reverse remodeling or clinical advantage of adding MVA to CABG at 1 year. 6 There was also a tendency toward higher complication rates and mortality in CABG plus MVA compared with CABG alone in high-risk patients.…”

Section: Author Perspectivementioning

confidence: 99%

Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass

Sun

Shi

Huang

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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In selected patients, preoperative moderate ischemic mitral regurgitation was relieved by off-pump coronary artery bypass grafting. Greater ejection fraction, greater posterior-inferior volume ratio, and early operation timing after infarction may predict the improvement of moderate ischemic mitral regurgitation after off-pump coronary artery bypass grafting, suggesting that posterior-inferior regional remodeling, reserved ventricular function, and early revascularization are important to the outcome.

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“…The overwhelming majority of previous studies have focused on evaluating the effects of CABG plus mitral valve repair on the treatment of moderate IMR 1–6,8–11 . Only a few studies have paid attention to the risk factors associated with IMR recurrence after mitral valve repair in addition to CABG for the treatment of moderate IMR.…”

Section: Introductionmentioning

confidence: 99%

Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation

Zhao²,

Shen

et al. 2020

J Card Surg

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Background and Aim Ischemic mitral regurgitation (IMR) recurrence after combined coronary artery bypass grafting (CABG) and mitral valve repair does occur, with a prevalence of 20% to 30% at the 2‐ to 4‐year follow‐up. This single‐center study aims to identify the predictors of IMR improvement after surgical revascularization plus mitral valve repair for moderate IMR. Methods A total of 201 eligible patients were entered into an improved group (n = 141) or a control group (n = 60) according to whether moderate or more mitral regurgitation occurred at the 2‐year postoperative time point. Clinical outcomes between groups were compared. Results The left ventricular endo‐diastolic diameter (LVEDD), type of ring (rigid complete ring), and the use of repair techniques (restrictive annuloplasty associated with subvalvular and/or leaflet repair) were three predictors of IMR improvement after surgery (odds ratio [OR] = 0.921, 95% confidence interval [CI], 0.865‐0.976, P = .025; OR = 7.753, 95% CI, 3.168‐17.742, P < .001; and OR = 0.168, 95% CI, 0.076‐0.423, P = .004, respectively). The cutoff value of the LVEDD was 65 mm with a sensitivity of 80.0% and a specificity of 65.2%. Patients in the improved group compared with those in the control group demonstrated better cumulative survival during a median follow‐up of 41.0 months (χ2 = 4.559, logrank P = .033) and a reduced ratio of the New York Heart Association class III‐IV at the latest follow‐up (5.7% vs 38.4%, P < .001). Conclusions An LVEDD of less than 65 mm, the use of a rigid complete ring, and combined restrictive annuloplasty and subvalvular and/or leaflet repair are associated with IMR improvement after CABG plus mitral valve repair for the treatment of moderate IMR; IMR improvement 2 years after surgery is associated with improved midterm outcomes.

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Effect of systematic downsizing rigid ring annuloplasty in patients with moderate ischemic mitral regurgitation

Cited by 47 publications

References 18 publications

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

Predictors of moderate ischemic mitral regurgitation improvement after off-pump coronary artery bypass

Predictors of ischemic mitral regurgitation improvement after surgical revascularization plus mitral valve repair for moderate ischemic mitral regurgitation

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