Is repair preferable to replacement for ischemic mitral regurgitation?

Gillinov, A. Marc; Wierup, Per; Blackstone, Eugene H.; Bishay, Ehab; Cosgrove, Delos M.; White, Jennifer A.; Lytle, Bruce W.; McCarthy, Patrick M.

doi:10.1067/mtc.2001.116557

Cited by 496 publications

(379 citation statements)

References 26 publications

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“…35,36 Mitral valve replacement, largely employed in the past in ischaemic regurgitation, although eliminates the short-term risk of recurrent MR, it is associated with poor long-term survival. 37 Thus, in our actual policy, we do not consider MV replacement as a reasonable alternative to repair.…”

Section: Discussionmentioning

confidence: 99%

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

Gelsomino

Lorusso²,

Cicco³

et al. 2007

European Heart Journal

117

102

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AimsWe present 5-year echocardiographic results of combined undersizing mitral ring annuloplasty (UMRA) and coronary artery bypass grafting (CABG) in chronic ischaemic mitral regurgitation (CIMR). Methods and resultsTwo hundred and fifty-one patients (aged 68.4 + 8.1, 62.5% male) undergoing combined CABG and UMRA in our Institution (Cardiac Surgery, Careggi Hospital, Florence, Italy) between September 2001 and March 2007 were prospectively enrolled in the study. Median follow up was 32.9 months [interquartile range (IQR) 17.5-51.6]. Fourteen patients with significant residual mitral regurgitation (MR) needing immediate intraoperative revision (n ¼ 3) or at discharge (n ¼ 11) were excluded from the study. Serial echocardiograms were performed in 220 survivors at baseline, discharge, and annually thereafter. Additionally, 17 patients died (2 early and 15 late deaths) and were also excluded from the study. MR remained stable at 1 year and re-increased at 3 years (P , 0.001) and 5 years (P , 0.001). Fiveyear actuarial survival was 83.2 + 4.4. Five-year freedom from re-operation for failed repair was 78.2 + 4.9%. Mean systolic and diastolic diameters decreased significantly at discharge (P ¼ 0.001 and P ¼ 0.01, respectively) and at early follow up (P ¼ 0.004 and P ¼ 0.02) but raised at 3 years (P , 0.001) and 5 years (P , 0.001). Systolic and diastolic sphericity indexes improved at discharge (P , 0.001) remained stable at 1 year but they re-increased at 3-year control (P ¼ 0.006 and P ¼ 0.03, respectively) with a late raise exceeding the pre-operative value (P , 0.001). Left ventricular reverse remodelling was observed in 44.2% of the study population with 10.3% of patients showing further left ventricular dilatation. At multivariable model, end-systolic volume 145 mL, systolic sphericity index 0.7, myocardial performance index 0.9, and wall motion score index 1.5 were predictors of recurrent MR. ConclusionOur findings emphasize the need for improved repair technique and better patient selection to identify patients with anticipated repair failure who could benefit more from valve replacement or other procedure directly addressing ventricular tethering.--

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Section: Discussionmentioning

confidence: 99%

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

Gelsomino

Lorusso²,

Cicco³

et al. 2007

European Heart Journal

117

102

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“…Operative mortality has been reported between 5 and 18% with two-year survival rates of 70% and five-year survival rates of 61%. [13][14][15][16] However, recent studies have shown that valve surgery does not improve survival in patients with left ventricular dysfunction. 17,18 Therefore, different percutaneous techniques were developed, offering an alternative treatment for MR in patients who are poor candidates for surgery.…”

Section: Follow-up Resultsmentioning

confidence: 99%

Percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population

Branden

Post²,

Swaans³

et al. 2010

NHJL

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437orIgInAl ArtIcle percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population Background. Percutaneous mitral valve (MV) repair using the edge-to-edge clip technique might be an alternative for patients with significant mitral regurgitation (MR) and an unacceptably high risk for operative repair or replacement. We report the short-term safety and efficacy of this new technique in a high-risk population. Methods. All consecutive high-risk patients who underwent percutaneous MV repair with the

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“…Finalmente, adoptamos el anillo de Carpentier-McCarthy-Adams, especialmente diseñado para la insufi ciencia mitral isquémica ventricular, que incorpora ya una sobre-reducción del diámetro ántero-posterior y una tracción hacia el plano auricular de la porción póstero-medial del anillo mitral, que es la que experimenta mayor tracción hacia apical en el infarto inferior, principal causa de una insufi ciencia mitral isquémica ventricular 28 . Si bien no fue un objetivo de este trabajo precisar cuando la revascularización miocárdica exclusiva o el reemplazo mitral serían el procedimiento de elección, pero sí es motivo de mucha discusión en la literatura 15,[29][30][31] , es conveniente precisar que en nuestra práctica actual cuando la insufi ciencia mitral es poco signifi cativa ( 2+) y el miocardio se presume viable, en general consideramos que la revascularización miocárdica exclusiva es sufi ciente para tratar la insufi ciencia mitral isquémica. En el otro extremo, en insuficiencias mitrales severas (4+), con gran disfunción ventricular, y en pacientes especialmente graves, consideramos el reemplazo mitral de elección, ya que el benefi cio de conservar la integridad de la válvula mitral se anula por el daño ventricular izquierdo intrínseco y la gravedad de los pacientes no hace conveniente aplicar un procedimiento que puede fallar y requerir de un segundo período de circulación extracorpórea.…”

Section: Discussionunclassified

Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica

et al. 2011

Rev. méd. Chile

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Is repair preferable to replacement for ischemic mitral regurgitation?

Abstract: Late survival is poor after surgery for ischemic mitral regurgitation. Most patients with ischemic mitral regurgitation benefit from mitral valve repair. In the most complex, high-risk settings, survivals after repair and replacement are similar.

Cited by 496 publications

References 26 publications

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

Five-year echocardiographic results of combined undersized mitral ring annuloplasty and coronary artery bypass grafting for chronic ischaemic mitral regurgitation

Percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population

Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica

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