Mitral-Valve Repair versus Replacement for Severe Ischemic Mitral Regurgitation

By Michael A. Acker, Michael K. Parides, Louis P. Perrault, Alan J. Moskowitz, A. Gelijns, P. Voisine, Peter K. Smith, Judy Hung, Eugene H. Blackstone, J. Puskas and 18 more. New England Journal of Medicine, 2013

819 citations recorded by the source corpus.

Background Ischemic mitral regurgitation is associated with a substantial risk of death. Practice guidelines recommend surgery for patients with a severe form of this condition but acknowledge that the supporting evidence for repair or replacement is limited. Methods We randomly assigned 251 patients with severe ischemic mitral regurgitation to undergo either mitral-valve repair or chordal-sparing replacement in order to evaluate efficacy and safety. The primary end point was the left ventricular end-systolic volume index (LVESVI) at 12 months, as assessed with the use of a Wilcoxon rank-sum test in which deaths were categorized below the lowest LVESVI rank. Results At 12 months, the mean LVESVI among surviving patients was 54.6±25.0 ml per square meter of body-surface area in the repair group and 60.7±31.5 ml per square meter in the replacement group (mean change from baseline, −6.6 and −6.8 ml per square meter, respectively). The rate of death was 14.3% in the repair group and 17.6% in the replacement group (hazard ratio with repair, 0.79; 95% confidence interval, 0.42 to 1.47; P = 0.45 by the log-rank test). There was no significant between-group difference in LVESVI after adjustment for death (z score, 1.33; P = 0.18). The rate of moderate or severe recurrence of mitral regurgitation at 12 months was higher in the repair group than in the replacement group (32.6% vs. 2.3%, P<0.001). There were no significant between-group differences in the rate of a composite of major adverse cardiac or cerebrovascular events, in functional status, or in quality of life at 12 months. Conclusions We observed no significant difference in left ventricular reverse remodeling or survival at 12 months between patients who underwent mitral-valve repair and those who underwent mitral-valve replacement. Replacement provided a more durable correction of mitral regurgitation, but there was no significant between-group difference in clinical outcomes. (Funded by the National Institutes of Health and the Canadian Institutes of Health; ClinicalTrials.gov number, NCT00807040.)

Subfields: Cardiology and Cardiovascular Medicine, Surgery

View Paper: https://www.semanticscholar.org/paper/8ea909dc404002c44b3a2100660e6e95996942c0

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In Cardiology and Cardiovascular Medicine

Citations in the corpus

[2017 ESC/EACTS Guidelines for the management of valvular heart disease]. (2017, background): “The optimal surgical approach remains controversial.(136) While mitral valve repair with an undersized complete ring to restore leaflet coaptation and valve competence is the preferred technique, valve replacement should be considered in patients with echocardiographic risk factors for residual or r”
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure (2016, neutral): “Also, there is no evidence favouring mitral valve repair over replacement in the context of better outcomes and magnitude of LV remodelling.(502) In the presence of AF, atrial ablation and LA appendage closure may be considered at the time of mitral valve surgery.”