Mitral Valve Repair or Replacement for Ischaemic Mitral Regurgitation: A Systematic Review

Rao, Christopher; Murphy, Maureen; Saso, Srdjan; Pandis, Dimosthenis; Grapsa, Julia; Nihoyannopoulos, Petros; Reeves, Barnaby C; Athanasiou, Thanos

doi:10.1016/j.hlc.2011.03.012

Cited by 10 publications

(2 citation statements)

References 51 publications

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“…Most are undergoing A B D E C preclinical evaluation, but a few have moved into early feasibility studies. If these devices can mitigate the increased operative risk associated with surgical valve replacement while still offering freedom from MR recurrence, they may well become the preferred percutaneous option (33). However, the field is still in its infancy and there are many hurdles to overcome.…”

Section: Replacementmentioning

confidence: 99%

Transcatheter interventions for functional mitral regurgitation

Chancellor

Schubert

Ailawadi

2018

Ann. Cardiothorac. Surg.

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Mitral regurgitation is considered the most prevalent valve disease in the United States and its incidence is increasing due to the aging population. Surgical mitral valve repair and replacement are effective at reducing regurgitation due to ischemia, but many patients with secondary mitral regurgitation do not undergo surgery because they are too high risk. Transcatheter devices that mimic surgical techniques are rapidly being developed to reduce the risks traditionally associated with surgical mitral valve repair and replacement. Despite the challenges posed by complex anatomy and multiple etiologies of mitral valve pathology, early results of transcatheter mitral repair and replacement indicate that they have the potential to increase the number of patients with secondary MR who are candidates for intervention.

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Section: Replacementmentioning

confidence: 99%

Transcatheter interventions for functional mitral regurgitation

Chancellor

Schubert

Ailawadi

2018

Ann. Cardiothorac. Surg.

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“…So far, no randomised clinical trial comparing mortality and morbidity after MPL versus MVR has been undertaken. Hence, our information is based on the majority of observational studies showing some evidence for better survival from MPL as compared to MVR [1,2] The risk of thromboembolism was lower in MPL without increasing frequency of re operation for MPL as compared to MVR. Better survival of MPL as compared to MVR has been observed for patients with specific aetiologies (rheumatic, mixed or degenerative).…”

Section: Introductionmentioning

confidence: 99%

Outcome of mitral valve plasty or replacement: atrial fibrillation an effect modifier

Vengen

Abdelnoor

Westheim

et al. 2013

J Cardiothorac Surg

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BackgroundAdvances in the understanding of mitral valve pathology have laid to mitral valve plasty (MPL) as the procedure of choice of all the mitral intervention as compared to mitral valve replacement (MVR).This study is aimed to compare the outcome mortality and reoperation and to estimate failure of repair between the two procedures during the follow up time.Material and methodsA cohort of 355 patients with mitral valve disease operated between January 1993 to January 2007 with closing date first of mars 2011. There were 214 MPL and 141 MVR at the Hospital discharge. This retrospective cohort had the design of exposed (MPL) versus non-exposed (MVR) with outcome total mortality and reoperation during follow up. Also echocardiography follow-up was undertaken to estimate the true long-term failure rate of repair.ResultsThe mean follow up was 5.3 years SE (3.82) maximum follow up was 14.1 years. Considering the patient time model the association between repair/replacement and total mortality RR = 0.43 95% (0.28-074) p = 0.002 controlling for the confounding effect of 3-vessels disease. Those results were confirmed by propensity score analysis.As far as outcome re-operation, presence of atrial fibrillation AF was an effect modifier indicating lower reoperation rate for MPL compared to MVR for patients without AF, RR = 0.32 95% CL (0.13-0.81) p = 0.017 while no difference in reoperation rates between MPL/MVR for patients with AF RR = 1.82 95% CL (0.52-6.4) p = 0.344.Echocardiography follows up showed incidence of moderate and severe recurrent mitral regurgitation was 1.34 per 100 patients years and 0.27 per 100 patients years during the follow-up time.ConclusionIn a cohort of patient with mitral valve disease undergoing MPL/MVR was examined. MPL was associated with better survival, and lower reoperation rate for patients without AF but same rate for patients with AF. We advocate more attention in controlling risk factors of AF in the clinical management of mitral disease. Long-term failure rate of MPL was low during follow up time. A replication of our results by a randomized clinical trial is mandatory.

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