Mitral Valve Repair Versus Replacement in Elderly With Degenerative Disease: Analysis of the STS Adult Cardiac Surgery Database

Hendrix, Ryan J.; Bello, Ricardo; Flahive, Julie; Kakouros, Nikolaos; Aurigemma, Gerard P.; Keaney, John F.; Hoffman, William D.; Vassileva, Christina M.

doi:10.1016/j.athoracsur.2018.09.018

Cited by 40 publications

(39 citation statements)

References 18 publications

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“…Isolated posterior leaflet prolapse is the most common abnormality seen in degenerative mitral regurgitation (MR), and is the main etiology of mitral valve (MV) disease in Western countries, which is gradually becoming prevalent worldwide (1,2). MV repair is increasingly used to restore leaflet morphology and left ventricular (LV) function due to its excellent long-term outcomes, and is the recommended treatment in clinical guidelines (3)(4)(5)(6)(7). Leaflet resection and chordal replacement are repair techniques that continue to evolve.…”

Section: Introductionmentioning

confidence: 99%

Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse

Ma¹,

Liu²,

Wei³

et al. 2021

Ann Transl Med

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Background:The aims of the present study was to compare midterm results of quadrangular leaflet resection versus chordal replacement for the repair of degenerative posterior mitral leaflet (PML) prolapse, and to explore the risk factors for recurrent severe mitral regurgitation (MR). Methods: From January 2012 to December 2018, 1,423 consecutive patients underwent mitral valve (MV) repair. A total of 317 had degenerative PML prolapse and constituted the study population. Of these, 74 (23.3%) underwent quadrangular leaflet resection, and 243 (76.7%) underwent chordal replacement.Outcomes were compared by using unadjusted data and propensity score-matched analyses.Results: Patients with multiple leaflet prolapse were more likely to undergo chordal replacement (18.4% vs. 41.9%, P<0.001), and performed as a minimally invasive approach (47.3% vs. 61.7%, P=0.027). Of the entire cohort, 1 death (0.3%) occurred due to intraoperative aortic dissection, and 1 patient who had undergone chordal replacement required reoperation before discharge for posterior leaflet tearing. There was no significant difference in the probability of freedom from recurrent severe MR at 82 months between the resection and neochordae groups in both the pre-matched (95.6% vs. 88.8%, P=0.105) and matched (95.2% vs. 88.5%, P=0.170) cohorts, which was consistent across all of the examined subgroups (P>0.05).Multivariate Cox regression indicated that dilated left ventricular end-systolic diameter (LVESD) was an independent risk factor for recurrent severe MR [<40 vs.

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Section: Introductionmentioning

confidence: 99%

Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse

Ma¹,

Liu²,

Wei³

et al. 2021

Ann Transl Med

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“…We congratulate Murashita and colleagues [1] for their highvolume study reported in The Annals of Thoracic Surgery. Patients whose main disorder was aortic insufficiency (patients with moderate or higher aortic stenosis were excluded from the study) were treated with aortic valve repair (97 patients), mechanical valve replacement (206 patients), bioprosthetic valve (227 patients) or homograft (7 patients) valve replacement.…”

Section: Survival In Aortic Regurgitation and Preoperative Ejection Fmentioning

confidence: 94%

“…A 19-mm valve will not cause a problem in a patient with a low BSA, whereas in a patient with a higher BSA, a 19-mm valve may create pressure gradient and may negatively affect results. In the study, Murashita and colleagues [1] did not share any information on whether pressure gradient was measured during follow-up of their patients. We believe that valve sizes according to BSA may affect results.…”

Section: Survival In Aortic Regurgitation and Preoperative Ejection Fmentioning

confidence: 99%

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Survival in Aortic Regurgitation and Preoperative Ejection Fraction

Cakir

Dönmez

Yurekli

et al. 2019

The Annals of Thoracic Surgery

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“…3 These findings were confirmed by recent publications. 4 An analysis of the STS database performed by Hendrix et al 5 in patients with degenerative MR demonstrated lower early mortality in repair compared to all the techniques of replacement (no, partial, or complete chordal preservation).…”

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confidence: 99%

Mitral valve repair for mitral regugitation in the elderly: Yes, we have to, but look at the etiologies!

Calafiore

Marco

Guarracini

et al. 2021

Journal of Cardiac Surgery

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The meta-analysis by Di Tommaso et al. demonstrated as elderly patients with mitral regurgitation (MR) undergoing mitral valve repair had lower short-term mortality and higher long-term survival with respect to patients undergoing mitral valve replacement. The benefit of repair is such, that initial surgical strategy is advisable in the elderly even in case of mild symptoms if compared with conservative management. However, even if repair can be performed in presence of some specific etiologies, as degenerative MR or secondary MR, there are always cases where a replacement can be an acceptable solution compared to a repair with uncertain future, regardless of our believes and our technical ability.

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Mitral Valve Repair Versus Replacement in Elderly With Degenerative Disease: Analysis of the STS Adult Cardiac Surgery Database

Cited by 40 publications

References 18 publications

Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse

Quadrangular resection versus chordal replacement for degenerative posterior mitral leaflet prolapse

Survival in Aortic Regurgitation and Preoperative Ejection Fraction

Mitral valve repair for mitral regugitation in the elderly: Yes, we have to, but look at the etiologies!

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