Repair or replacement for severe ischemic mitral regurgitation

Wang, Xinxin; Zhang, Bo; Zhang, Jian; Ying, Yongquan; Zhu, Chengchu; Chen, Baofu

doi:10.1097/md.0000000000011546

Cited by 21 publications

(12 citation statements)

References 51 publications

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“…While mortality did not differ between groups in the CTSN trial, the trial was not powered to detect differences in survival. In contrast, a recent meta-analysis that included this CTSN trial [19] and previous five meta-analyses [20][21][22][23][24] reported lower 30-day mortality associated with MVr compared to MVR.…”

Section: Discussionmentioning

confidence: 56%

Predictors of hospital mortality after surgery for ischemic mitral regurgitation

Elhenawy

Algarni

Rao

et al. 2020

Preprint

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BACKGROUND: The benefit of mitral valve repair over replacement in patients with ischemic mitral regurgitation is still controversial. We report our early postoperative outcomes of repair versus replacement. METHODS: Data were collected for patients undergoing first-time mitral valve surgery for ischemic mitral regurgitation between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. RESULTS: Valve repair was performed in 42% (n=164) of patients and replacement in 58% (n=229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < 0.05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% versus 5%, p = 0.01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular function were independent predictors of hospital mortality. Importantly, mitral valve repair versus replacement was not an independent predictor of hospital mortality. CONCLUSION: Our data did not suggest an early survival benefit to mitral valve repair over replacement for ischemic mitral regurgitation. However, age, left ventricular dysfunction, and the need for urgent surgery were independently associated with hospital mortality.

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Section: Discussionmentioning

confidence: 56%

Predictors of hospital mortality after surgery for ischemic mitral regurgitation

Elhenawy

Algarni

Rao

et al. 2020

Preprint

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show abstract

“…While mortality did not differ between groups in the CTSN trial, the trial was not powered to detect differences in survival. In contrast, a recent meta‐analysis that included this CTSN trial 19 and the previous five meta‐analyses 20–24 reported lower 30‐day mortality associated with MVr compared to MVR.…”

Section: Discussionmentioning

confidence: 69%

Predictors of hospital mortality after surgery for ischemic mitral regurgitation: the Toronto General Hospital experience

et al. 2020

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Background: The benefit of mitral valve repair (MVr) over replacement in patients with severe ischemic mitral regurgitation (IMR) is still controversial. We report our early postoperative outcomes of repair versus replacement. Methods: Data were collected for patients undergoing first-time mitral valve surgery for severe IMR between 1990 and 2009 (n = 393). Patients who underwent combined procedures for papillary muscle rupture, post-infarction ventricular septal defect, endocarditis, or any previous cardiac surgery were excluded. Preoperative demographics, operative variables, and hospital outcomes were analyzed, and multivariable regression analysis was employed to identify independent predictors of hospital mortality. Results: Valve repair was performed in 42% (n = 164) of patients and replacement in 58% (n = 229). Patients who underwent replacement were older and had a higher prevalence of unstable angina, New York Heart Association Class IV symptoms, preoperative cardiogenic shock, preoperative myocardial infarction, peripheral vascular disease, renal failure, and urgent or emergency surgery (all p < .05). Unadjusted hospital mortality was higher in patients undergoing valve replacement (13% vs. 5%; p = .01). Valve repair was associated with a lower prevalence of postoperative low cardiac output syndrome. Multivariable analysis revealed that age, urgency of operation, and preoperative left ventricular (LV) function were independent predictors of hospital mortality. Importantly, MVr versus replacement was not an independent predictor of hospital mortality. Conclusion: Our data did not suggest an early survival benefit to MVr over replacement for IMR. However, age, LV dysfunction, and the need for urgent surgery were independently associated with hospital mortality.

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“…Similarly, MVP patients with associated heart failure had more percutaneous mitral procedures. Secondary MR was associated with poor prognosis, and the efficacy of surgical treatment and percutaneous MVR is still being discussed [ 13 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Fourteen-Year Temporal Trends in Patients Hospitalized for Mitral Regurgitation: The Increasing Burden of Mitral Valve Prolapse in Men

Grave

Tribouilloy

Tuppin

et al. 2022

JCM

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Mitral regurgitation (MR) is the second most common valvular heart disease in Europe. The aging of the population and the increase in post-infarction survival could increase the prevalence of MR. To estimate the burden of patients hospitalized for MR in France in 2019 and temporal trends by etiology and sex from 2006 to 2020, we selected all patients hospitalized for MR using the national hospital database. In 2019, 49.2% of such patients had mitral valve prolapse (MVP), 17.1% had ischemic MR, 9.9% had rheumatic MR and 4.4% had MR with cardiomyopathy. The mean age of MVP patients was 67.8 years, and 34% were women. Among 89% of MVP inpatients who had received mitral valve repair or replacement, 55% received surgical repair, 13% received percutaneous repair and 25% received replacement. The all-cause mortality of one year after a mitral procedure of MVP was 5.4%. Among ischemic MR inpatients, 29% have had a mitral valve replacement, 16% a surgical repair and 19% a percutaneous repair. Between 2006 and 2019, the age-standardized rates of patients hospitalized for MVP have increased by 60%, especially in men (+80%) with 5.3/100,000 Person-Years (PY). The age-standardized rates of patients hospitalized for ischemic MR have increased by 25% with 1.8/100,000 PY; that of rheumatic MR has decreased by 36%. The study found that the burden of MVP in hospitals has increased substantially, especially among men. These results emphasize the need to monitor these temporal trends and anticipate care needs in the coming years.

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Repair or replacement for severe ischemic mitral regurgitation

Cited by 21 publications

References 51 publications

Predictors of hospital mortality after surgery for ischemic mitral regurgitation

Predictors of hospital mortality after surgery for ischemic mitral regurgitation

Predictors of hospital mortality after surgery for ischemic mitral regurgitation: the Toronto General Hospital experience

Fourteen-Year Temporal Trends in Patients Hospitalized for Mitral Regurgitation: The Increasing Burden of Mitral Valve Prolapse in Men

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