Long-Term Outcomes following Repair or Replacement in Degenerative Mitral Valve Disease

Zhou, Yu‐Fu; Léobon, Bertrand; Berthoumieu, Pierre; Roux, Daniel; Glock, Y; Mei, Yunqing; Wang, Y. W.; Fournial, G

doi:10.1055/s-0029-1240925

Cited by 31 publications

(30 citation statements)

References 26 publications

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“…Better preoperative NYHA classification and ejection fraction have been shown to be very strong predictors of survival. In the majority of the studies, ejection fraction was not significantly different, however NYHA status was better in half of the studies in the MVP group [19-22]. Additionally, age and female gender have also been shown to be poor predictors of post-operative outcomes including survival [23-27].…”

Section: Methodsmentioning

confidence: 99%

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

McNeely¹,

Vassileva²

2014

CCR

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The short-term advantage of mitral valve repair versus replacement for degenerative disease has been extensively documented. These advantages include lower operative mortality, improved survival, better preservation of left-ventricular function, shorter post-operative hospital stay, lower total costs, and fewer valve-related complications, including thromboembolism, anticoagulation-related bleeding events and late prosthetic dysfunction. More recent written data are available indicating the long-term advantage of repair versus replacement. While at some institutions, the repair rate for degenerative disease may exceed 90%, the national average in 2007 was only 69%. Making direct comparisons between mitral valve repair and replacement using the available studies does present some challenges however, as there are often differences in baseline characteristics between patient groups as well as other dissimilarities between studies. The purpose of this review is to systematically summarize the long-term survival and reoperation data of mitral valve repair versus replacement for degenerative disease. A PubMed search was done and resulted in 12 studies that met our study criteria for comparing mitral valve repair versus replacement for degenerative disease. A systematic review was then conducted abstracting survival and reoperation data.

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Section: Methodsmentioning

confidence: 99%

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

McNeely¹,

Vassileva²

2014

CCR

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“…15) Five-year-survival rates of degenerative mitral valve patients are given for repair and replacement patients as 84.3% and 64.6% respectively. 6) Many studies have showed that repair is better than replacement in terms of operative mortality, morbidity, survival, endocarditis and thromboembolic complications. 13,14) Although the reoperation ratios are suggested to be similar, there are studies referring to high reoperation ratios in the ischemic mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

“…3,4) Although thromboembolic complications in the mechanical valves and early degeneration of biological valves were the major disadvantages of mitral valve replacement (MVR), due to the high achievement drive of the method in terms of early post-surgical rehabilitation, it was used as the preferred method in the mitral valve surgery for many years. [5][6][7] However, during the last ten years, thanks to the better standardized rehabilitation techniques, surgeons gained experience and in this way mitral valve repair (MvRp) has become the preferred method in mitral valve surgery. 5,6) The success of the mitral operations has increased due to the standardization of surgical techniques and comprehensive post-operative intensive care.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7] However, during the last ten years, thanks to the better standardized rehabilitation techniques, surgeons gained experience and in this way mitral valve repair (MvRp) has become the preferred method in mitral valve surgery. 5,6) The success of the mitral operations has increased due to the standardization of surgical techniques and comprehensive post-operative intensive care. 6) Following the positive effects of that success on patients, the effect on patient's quality of life started to be evaluated.…”

Section: Introductionmentioning

confidence: 99%

“…5,6) The success of the mitral operations has increased due to the standardization of surgical techniques and comprehensive post-operative intensive care. 6) Following the positive effects of that success on patients, the effect on patient's quality of life started to be evaluated. [8][9][10] There are not many studies evaluating the effects of MvRp and MVR on the quality of life.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the Health Related Quality of Life of Patients Following Mitral Valve Surgical Procedures in the 6-Months Follow-up: A Prospective Study

Kara

Aydın

et al. 2013

ATCS

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Purpose: The aim of the present study is to evaluate the health-related quality of life of the patients who underwent mitral valve repair (MvRp) and mitral valve replacement (MVR). Methods: Within the scope of this prospective study design, 56 patients who had mitral valve operation between the years of 2011-2012 were enrolled in the study. 24 (42.8%) of these patients had MVR while 32 (57.1%) of them had MvRp. The health-related quality of life was evaluated according to the Turkey norms of Short Form 36 Quality-Of-Life Measures (SF-36), which were filled in by the patients before and 6 months after the operation. Moreover, preoperative risk factors affecting the quality of life (age, gender, functional capacity, rhythm, hypertension, diabetes, applied surgical method and echocardiographic results) were investigated for all the patients (n = 56) by using independent sample t test analysis. Results: When the pre and postoperative changes were compared between the two groups, it was found out that there were no significant difference between the groups in terms of restraints on physical role functioning (PR), and the social role functioning values (SF) (respectively; p = 0.097, p = 0.105). However, in the comparison of pre-/postoperative changes between the groups, the changes in physical functioning (PF), bodily pain (BP), general health (GH), vitality (VT) and restraints on emotional role functioning (RE) and mental health (MH) values were found out to be significantly superior in the MvRp group than in the MVR group (respectively; p <0.01, p <0.05, p <0.01, p <0.01, p <0.05 and p <0.01). It was also confirmed that female gender, atrial fibrillation (AFR), and MVR method negatively affected the physical and mental components (respectively; p = 0.033, p = 0.003, p = 0.015). Conclusion: Results of the SF-36 quality of life measures show that quality of life may be better in patients that have had MvRp. It should be considered that the planned surgical treatment method can affect the patient's quality of life, and this effect can indicate the success of the surgical treatment.

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Invasive hemodynamics are equivocal for functional outcomes after MitraClip

Power

Reiff

Tsangaris

et al. 2022

Health Science Reports

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Objectives To evaluate invasive hemodynamics in assessing MC therapy success as well as evaluate its effectiveness as a predictor of functional outcomes. Background Mitral regurgitation grade is a poor predictor of functional outcomes after a MitraClip. There is a paucity of data on invasive hemodynamics as a predictor of outcomes. Methods Sixty‐nine patients underwent MC between 2015 and 2018 at the University of Minnesota Medical Center and were retrospectively analyzed. Invasive hemodynamics were performed before and after device deployment with transesophageal echocardiographic guidance. Statistical analysis was performed using STATA version 16. Student's t test was used for continuous variables and Pearson's chi‐squared test for categorical variables. Mann‐Whitney test was performed for continuous variables where data were not normally distributed. Logistic and linear regression were used to investigate relationships between variables and outcomes. Results A total of 69 patients were included in the study. The mean age was 83 (75‐87) years and 38 (55%) were male. Eighty‐one percentage had >/= NYHA III symptoms. Eighty‐seven percentage had severe MR. Pulmonary capillary wedge pressure was 20 (15‐24). Overall, there was significant improvement in left atrial pressure including mean left atrial pressure index, MR, and NYHA class after MC (<.001). There was no significant association between invasive hemodynamics (including left atrial mean pressure index or its reduction rate) and functional outcomes (p = NS). MR grade was also not predictive of functional outcomes. Conclusion Left atrial pressure may not be a significant predictor of functional outcomes, and, in isolation, may not be an improvement over MR grade.

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Long-Term Outcomes following Repair or Replacement in Degenerative Mitral Valve Disease

Abstract: MVP is superior to MVR for the treatment of degenerative MR despite the impact of repair failure. Age less than 60 years, ring size to body surface area greater than 19.0, absence of a prosthetic ring and residual MR at the end of surgery (≥ 1/4) reduce the durability of MVP.

Cited by 31 publications

References 26 publications

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

Long-term Outcomes of Mitral Valve Repair Versus Replacement for Degenerative Disease: A Systematic Review

Comparison of the Health Related Quality of Life of Patients Following Mitral Valve Surgical Procedures in the 6-Months Follow-up: A Prospective Study

Invasive hemodynamics are equivocal for functional outcomes after MitraClip

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